Provider Demographics
NPI:1669421673
Name:GREENSTEIN, JODI LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:GREENSTEIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:CHRISTOPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 GOLDEN VALLEY ROAD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4298
Mailing Address - Country:US
Mailing Address - Phone:763-520-0483
Mailing Address - Fax:763-520-0355
Practice Address - Street 1:3915 GOLDEN VALLEY ROAD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4298
Practice Address - Country:US
Practice Address - Phone:763-520-0483
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN40003820Medicaid
HP32919OtherHEALTH PARTNERS
90353GROtherBCBS MINNESOTA