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General NPI Number Information
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NPI Number | 1588938427
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Entity Type | Individual
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Provider Name | MS. SELENE LEELAM MEHTA
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Gender | Female
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 721 S QUENTIN RD
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City | PALATINE
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State | IL
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Zip | 60067-6778
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Country | US
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Telephone | 847-359-7490
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Fax | 847-359-7525
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Provider Business Mailing Address
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Address Line | 628 N CHARTER HALL DR
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City | PALATINE
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State | IL
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Zip | 60067-8678
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Country | US
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Telephone | 847-212-9337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149008544
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License Number State | IL
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