Provider Demographics
NPI:1407973076
Name:CHETHIK, LEIGH PAUL (PHD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:PAUL
Last Name:CHETHIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W IRVING PARK RD
Mailing Address - Street 2:202
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3123
Mailing Address - Country:US
Mailing Address - Phone:773-509-4966
Mailing Address - Fax:773-279-1201
Practice Address - Street 1:655 W IRVING PARK RD
Practice Address - Street 2:202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3123
Practice Address - Country:US
Practice Address - Phone:773-509-4966
Practice Address - Fax:773-279-1201
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical