MEDICARE: KAREN BETH GREENBERG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150-011163	IL
2	1041C0700X	Clinical Social Worker	149-013491	IL

General Provider Information

NPI Number	:	1144414210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN BETH GREENBERG LCSW

Provider Business Mailing Address
First Line	:	2415 MCDANIEL AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-2152
Country	:	US
Telephone Number	:	312-203-9648
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 CHURCH ST STE 247
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3840
Country	:	US
Telephone Number	:	312-203-9648
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	06/11/2021

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