Provider Demographics
NPI:1881316784
Name:GREEN, MADELYN G (LCSW)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:G
Last Name:GREEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:G
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 LINCOLNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5210
Mailing Address - Country:US
Mailing Address - Phone:847-651-7858
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 380
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7710
Practice Address - Country:US
Practice Address - Phone:708-252-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
IL1490289701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program