Individual provider Active NPI

Leigh Paul Chethik, PHD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1407973076
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
655 W Irving Park Rd
202
Chicago, IL 60613-3123
Phone
(773) 509-4966
Fax
(773) 279-1201
NPI assigned
Mar 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X IL Primary

Addresses

Primary practice location

655 W Irving Park Rd
202
Chicago, IL 60613-3123

Mailing address

655 W Irving Park Rd
202
Chicago, IL 60613-3123
Phone (773) 509-4966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060214000061 IL Practitioner - Clinical Psychologist 9638184583 Practice locations: Chicago, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4514 N Sacramento Ave
Chicago, IL 60625-3830
Phone (773) 504-6027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407973076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 W IRVING PARK RD",
            "address_2": "202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133123",
            "telephone_number": "773-509-4966",
            "fax_number": "773-279-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W IRVING PARK RD",
            "address_2": "202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133123",
            "telephone_number": "773-509-4966",
            "fax_number": "773-279-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHETHIK",
        "first_name": "LEIGH",
        "middle_name": "PAUL",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.