Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1959 | AZ |
N | 103T00000X | Psychologist | 1959 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1959 | AZ |
N | 103TA0700X | Adult Development & Aging Psychologist | 1959 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1959 | AZ |
N | 103G00000X | Clinical Psychologist | 1959 | AZ |
N | 103TC0700X | Clinical Psychologist | 1959 | AZ |
N | 103TC1900X | Counseling Psychologist | 1959 | AZ |
N | 103TF0000X | Family Psychologist | 1959 | AZ |
N | 103TP2701X | Group Psychotherapist | 1959 | AZ |
NPI | 1164552386 |
---|---|
Provider Name | Patricia Penn |
First Address | Tucson, AZ 85713-3353 |
Second Address | Tucson, AZ 85713-3353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
505191 | (05) | AZ |