Provider Demographics
NPI:1912447491
Name:GREEN, HILARY HALE (PSYD)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:HALE
Last Name:GREEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PORTER
Other - Middle Name:HALE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1300 W BELMONT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:872-588-0396
Mailing Address - Fax:773-880-1321
Practice Address - Street 1:1300 W BELMONT AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:872-588-0396
Practice Address - Fax:773-880-1321
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical