Provider Demographics
NPI:1679775704
Name:GREENE, MINNA CORWITH (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MINNA
Middle Name:CORWITH
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N MARINE DR FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7859
Mailing Address - Country:US
Mailing Address - Phone:773-275-6233
Mailing Address - Fax:773-275-6288
Practice Address - Street 1:4800 N MARINE DR FL. 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7859
Practice Address - Country:US
Practice Address - Phone:773-275-6233
Practice Address - Fax:773-275-6288
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021648800OtherBLUE CROSS BLUE SHEILD