Provider Demographics
NPI:1861640393
Name:CHIARIELLO, SAMANTHA (PSYD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CHIARIELLO
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15826 S LA GRANGE RD # 233
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7793
Mailing Address - Country:US
Mailing Address - Phone:708-864-4920
Mailing Address - Fax:
Practice Address - Street 1:15826 S LA GRANGE RD # 233
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-7793
Practice Address - Country:US
Practice Address - Phone:708-864-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007988103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623882OtherBCBS