Provider Demographics
NPI:1316723778
Name:ORTIZ-GREENE, CLEIDY EVELYNG (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:CLEIDY
Middle Name:EVELYNG
Last Name:ORTIZ-GREENE
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1235
Mailing Address - Country:US
Mailing Address - Phone:630-523-2393
Mailing Address - Fax:
Practice Address - Street 1:40 SKOKIE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1601
Practice Address - Country:US
Practice Address - Phone:312-543-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490257171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical