Maurissa Green, MED, BA, PEL

Primary specialty

School CounselorTaxonomy code 101YS0200X

License

2422001 Issued in IL

Practice address

900 Ridge Rd Ste 1S
Homewood, IL 60430-1934

Phone

(708) 637-1672

NPI assigned

Sep 27, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts, Master of Education

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MWC Foundation Inc.

  • Clinical Social Worker
  • Homewood, IL
  • NPI 1275145716
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1376214577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 OAK LN",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662030",
            "telephone_number": "312-918-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 RIDGE RD STE 1S",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604301934",
            "telephone_number": "708-637-1672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MAURISSA",
        "credential": "MED, BA, PEL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-27",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "IL",
            "license": "2422001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ram K Gopi, MD
• David Edmund Gottlieb, PH.D.
• Yvonne Grandberry
• Great Hands Home Services LLC
• Elisa N Green, M.A., CCC-SLP
• Tashunda Latrese Green, RN
• Deborah Greenberg, OTRL
• Terrance Greene
• William Paul Gress, D.C.
• Jessica Tiffany Griffin

• School Counselor in Homewood, IL
• Providers in Homewood, IL by specialty
• School Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.