Provider Demographics
NPI:1336855477
Name:GREEN, BRANDI MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MARIE
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 1:5256 S DREXEL AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3751
Mailing Address - Country:US
Mailing Address - Phone:773-885-2281
Mailing Address - Fax:
Practice Address - Street 1:605 N MICHIGAN AVE FL 4
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3141
Practice Address - Country:US
Practice Address - Phone:724-250-8855
Practice Address - Fax:724-788-0617
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1041C0700X
IL149.0243471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical