Provider Demographics
NPI:1235149626
Name:LEAMY, DIANE E (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:LEAMY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W. 55TH PLACE
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3410
Mailing Address - Country:US
Mailing Address - Phone:708-341-1627
Mailing Address - Fax:
Practice Address - Street 1:19 N. GRANT ST.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3363
Practice Address - Country:US
Practice Address - Phone:708-341-1627
Practice Address - Fax:630-325-3769
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490072281041C0700X
IL149.0072281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203671Medicare ID - Type Unspecified