Provider Demographics
NPI:1619684883
Name:GREEN, MARIA JUANITA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:JUANITA
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 WATERBURY DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8584
Mailing Address - Country:US
Mailing Address - Phone:773-641-3044
Mailing Address - Fax:
Practice Address - Street 1:101 1/2 E FRONT ST STE 104
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5334
Practice Address - Country:US
Practice Address - Phone:630-216-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150107081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker