Healthcare Provider Details

I. General information

NPI: 1699040147
Provider Name (Legal Business Name): ZOE LEIBOWITZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 01/27/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST # 525-4535
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

1 E ERIE ST # 525-4535
CHICAGO IL
60611-2740
US

V. Phone/Fax

Practice location:
  • Phone: 773-706-2815
  • Fax: 872-278-0660
Mailing address:
  • Phone: 773-706-2815
  • Fax: 872-278-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-009681
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: