Provider Demographics
NPI:1518079904
Name:MC LEOD, ANDREW CAMERON (PHD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CAMERON
Last Name:MC LEOD
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 1:1400 W GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2805
Mailing Address - Country:US
Mailing Address - Phone:773-508-6100
Mailing Address - Fax:773-262-4841
Practice Address - Street 1:1400 W GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2805
Practice Address - Country:US
Practice Address - Phone:773-508-6100
Practice Address - Fax:773-262-4841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
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