MEDICARE: MICHELLE ANNE GREEN 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	1041C0700X	Clinical Social Worker	149011403	IL

General Provider Information

NPI Number	:	1427272368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANNE GREEN LCSW

Provider Business Mailing Address
First Line	:	2615 THREE OAKS RD STE 2B
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-6119
Country	:	US
Telephone Number	:	224-523-0769
Fax Number	:	888-972-5628

Provider Business Practice Location Address
First Line	:	610 CRYSTAL POINT DR
Second Line	:	SUITE 3
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-1401
Country	:	US
Telephone Number	:	815-477-2270
Fax Number	:	815-477-2287

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	12/18/2025

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