Provider Demographics
NPI:1396047858
Name:GREENSTEIN, JUSTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:GREENSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S DAMEN AVE
Mailing Address - Street 2:JESSE BROWN VA MEDICAL CENTER, MHSL (116B)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3728
Mailing Address - Country:US
Mailing Address - Phone:312-569-5968
Mailing Address - Fax:312-569-8137
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:JESSE BROWN VA MEDICAL CENTER, MHSL (116B)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-5968
Practice Address - Fax:312-569-8137
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071007977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical