NPIMap

Individual provider Active NPI

Jenna Mary Felczak-Berberich, PSY.D.

  • Clinical Psychologist
  • Oak Lawn, IL
National Provider Identifier
1093067589
Registry record updated Jan 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071008426 Issued in IL
Practice address
4700 W 95TH St
Suite Lower Level 5
Oak Lawn, IL 60453-2533
Phone
(800) 216-1110
Fax
(708) 346-4868
NPI assigned
Oct 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071008426 IL Primary
Clinical Child & Adolescent Psychologist 103TC2200X 071008426 IL
Family Psychologist 103TF0000X 071008426 IL

Addresses

Primary practice location

4700 W 95TH St
Suite Lower Level 5
Oak Lawn, IL 60453-2533

Mailing address

4700 W 95TH St
Suite Lower Level 5
Oak Lawn, IL 60453-2533
Phone (800) 216-1110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
071008426ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation Past Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358294400000",
    "number": "1093067589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 W 95TH ST",
            "address_2": "SUITE LOWER LEVEL 5",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532533",
            "telephone_number": "800-216-1110",
            "fax_number": "708-346-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W 95TH ST",
            "address_2": "SUITE LOWER LEVEL 5",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532533",
            "telephone_number": "800-216-1110",
            "fax_number": "708-346-4868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELCZAK-BERBERICH",
        "first_name": "JENNA",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-08",
        "last_updated": "2013-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008426",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071008426",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "IL",
            "license": "071008426",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.