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General NPI Number Information
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NPI Number | 1427272368
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Entity Type | Individual
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Provider Name | MICHELLE ANNE GREEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 610 CRYSTAL POINT DR SUITE 3
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-1401
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Country | US
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Telephone | 815-477-2270
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Fax | 815-477-2287
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Provider Business Mailing Address
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Address Line | 2615 THREE OAKS RD STE 2B
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City | CARY
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State | IL
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Zip | 60013-6119
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Country | US
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Telephone | 224-523-0769
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Fax | 888-972-5628
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011403
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License Number State | IL
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