Provider Demographics
NPI:1003281882
Name:CHAN LEONG, CECILA (LCSW)
Entity type:Individual
Prefix:
First Name:CECILA
Middle Name:
Last Name:CHAN LEONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HAPP RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3413
Mailing Address - Country:US
Mailing Address - Phone:773-218-5322
Mailing Address - Fax:
Practice Address - Street 1:800 E NORTHWEST HWY
Practice Address - Street 2:SUITE 106B
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3457
Practice Address - Country:US
Practice Address - Phone:847-867-7924
Practice Address - Fax:847-299-4952
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL148.0008931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical