Provider Demographics
NPI:1386058196
Name:YOUTH SERVICES OF GLENVIEW-NORTHBROOK
Entity type:Organization
Organization Name:YOUTH SERVICES OF GLENVIEW-NORTHBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-724-2620
Mailing Address - Street 1:3080 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1210
Mailing Address - Country:US
Mailing Address - Phone:847-724-2620
Mailing Address - Fax:847-724-3499
Practice Address - Street 1:3080 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1210
Practice Address - Country:US
Practice Address - Phone:847-724-2620
Practice Address - Fax:847-724-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable