Provider Demographics
NPI:1164434171
Name:MANFREDINI, LISA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:MANFREDINI
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 1:53 W JACKSON BLVD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3606
Mailing Address - Country:US
Mailing Address - Phone:312-922-3483
Mailing Address - Fax:312-922-3951
Practice Address - Street 1:53 W JACKSON BLVD
Practice Address - Street 2:SUITE 625
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3606
Practice Address - Country:US
Practice Address - Phone:312-922-3483
Practice Address - Fax:312-922-3951
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical