Provider Demographics
NPI:1558745406
Name:MINDFUL CONNECTIONS BEHAVIORAL HEALTH PC
Entity Type:Organization
Organization Name:MINDFUL CONNECTIONS BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIZZIRRI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-351-8831
Mailing Address - Street 1:1413 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:IL
Mailing Address - Zip Code:60163-1464
Mailing Address - Country:US
Mailing Address - Phone:708-351-8831
Mailing Address - Fax:
Practice Address - Street 1:116 S YORK ST STE 201
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3432
Practice Address - Country:US
Practice Address - Phone:708-351-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150015385104100000X
IL1490096771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty