Provider Demographics
NPI:1164646915
Name:GREEN, SHAYNA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 BRITTANY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2103
Mailing Address - Country:US
Mailing Address - Phone:847-400-8559
Mailing Address - Fax:847-272-7350
Practice Address - Street 1:3504 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1821
Practice Address - Country:US
Practice Address - Phone:847-272-5111
Practice Address - Fax:847-272-7350
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical