Provider Demographics
NPI:1699756593
Name:CLEARY, HELEN P (PSYD)
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:P
Last Name:CLEARY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 LEICESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3445
Mailing Address - Country:US
Mailing Address - Phone:847-228-7021
Mailing Address - Fax:
Practice Address - Street 1:1190 LEICESTER RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3445
Practice Address - Country:US
Practice Address - Phone:847-228-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004657103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605362OtherBLUE CROSS BLUE SHEILD #
IL997890Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST