Provider Demographics
NPI:1639899776
Name:LEBERSFELD, JENNA BROOKE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:BROOKE
Last Name:LEBERSFELD
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 1:12751 S SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-2718
Mailing Address - Country:US
Mailing Address - Phone:561-322-5253
Mailing Address - Fax:
Practice Address - Street 1:6033 N SHERIDAN RD STE S7
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3013
Practice Address - Country:US
Practice Address - Phone:561-322-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010820103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist