Provider Demographics
NPI:1033530449
Name:CREATING CONNECTIONS PC
Entity Type:Organization
Organization Name:CREATING CONNECTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-297-2696
Mailing Address - Street 1:1300 W BELMONT AVE STE 407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3242
Mailing Address - Country:US
Mailing Address - Phone:773-297-2696
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELMONT AVE STE 407
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3242
Practice Address - Country:US
Practice Address - Phone:773-297-2696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005780103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622706OtherBLUE CROSS BLUE SHIELD PPO