1407271372 NPI number — MARGARET ELAINE GREENGARD LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407271372 NPI number — MARGARET ELAINE GREENGARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENGARD
Provider First Name:
MARGARET
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHILDRESS
Provider Other First Name:
MARGARET
Provider Other Middle Name:
GREENGARD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407271372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 S MAPLE AVE
Provider Second Line Business Mailing Address:
SUITE 5601
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60304-1091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-673-7762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 OAKBROOK CTR
Provider Second Line Business Practice Location Address:
SUITE 619
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-673-7762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.016307 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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