Provider Demographics
NPI:1427227669
Name:LEYDEN FAMILY SERVICE & MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:LEYDEN FAMILY SERVICE & MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:CHIARIELLO
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-451-0330
Mailing Address - Street 1:10001 GRAND AVE.
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131
Mailing Address - Country:US
Mailing Address - Phone:847-451-0330
Mailing Address - Fax:
Practice Address - Street 1:10200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131
Practice Address - Country:US
Practice Address - Phone:847-455-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04089261QM0801X
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618935OtherBCBS
IL984620Medicare UPIN
IL984620Medicare UPIN