Provider Demographics
NPI:1639628472
Name:GRIMBERG, LEIGH (LCPC, MA)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:GRIMBERG
Suffix:
Gender:F
Credentials:LCPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E ROOSEVELT RD STE 8
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6850
Mailing Address - Country:US
Mailing Address - Phone:608-618-1678
Mailing Address - Fax:
Practice Address - Street 1:1616 E ROOSEVELT RD STE 8
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6850
Practice Address - Country:US
Practice Address - Phone:630-588-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional