Provider Demographics
NPI:1093084998
Name:GREENE, VICKI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 14B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3957
Mailing Address - Country:US
Mailing Address - Phone:773-610-6165
Mailing Address - Fax:
Practice Address - Street 1:3300 N LAKE SHORE DR
Practice Address - Street 2:SUITE 14B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3957
Practice Address - Country:US
Practice Address - Phone:773-610-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004635103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical