Provider Demographics
NPI:1093067589
Name:FELCZAK-BERBERICH, JENNA MARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:MARY
Last Name:FELCZAK-BERBERICH
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 1:4700 W 95TH ST
Mailing Address - Street 2:SUITE LOWER LEVEL 5
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2533
Mailing Address - Country:US
Mailing Address - Phone:800-216-1110
Mailing Address - Fax:708-346-4868
Practice Address - Street 1:4700 W 95TH ST
Practice Address - Street 2:SUITE LOWER LEVEL 5
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2533
Practice Address - Country:US
Practice Address - Phone:800-216-1110
Practice Address - Fax:708-346-4868
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008426103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily