Provider Demographics
NPI:1356340665
Name:GREENFIELD, SHIRA R (LCPC)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:R
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CRYSTAL POINT DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1401
Mailing Address - Country:US
Mailing Address - Phone:815-735-6863
Mailing Address - Fax:
Practice Address - Street 1:610 CRYSTAL POINT DR
Practice Address - Street 2:SUITE 3
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1401
Practice Address - Country:US
Practice Address - Phone:815-735-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05619771OtherBCBS