Provider Demographics
NPI:1497489520
Name:GREENE, AMY MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARGARET
Last Name:GREENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4685
Mailing Address - Country:US
Mailing Address - Phone:708-226-2318
Mailing Address - Fax:708-226-2319
Practice Address - Street 1:15300 WEST AVE STE 108
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4685
Practice Address - Country:US
Practice Address - Phone:708-226-2318
Practice Address - Fax:708-226-2319
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490098271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical