Provider Demographics
NPI:1801180120
Name:LENGSFELDER, JEANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:
Last Name:LENGSFELDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1720
Mailing Address - Country:US
Mailing Address - Phone:510-705-1990
Mailing Address - Fax:510-809-8306
Practice Address - Street 1:300 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-1720
Practice Address - Country:US
Practice Address - Phone:510-705-1990
Practice Address - Fax:510-809-8306
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist