Provider Demographics
NPI:1033448485
Name:BARON, PENNY H (PHD,ATR-BC, LCAT)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:H
Last Name:BARON
Suffix:
Gender:F
Credentials:PHD,ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-5637
Mailing Address - Country:US
Mailing Address - Phone:607-844-3465
Mailing Address - Fax:
Practice Address - Street 1:445 FERGUSON RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-5637
Practice Address - Country:US
Practice Address - Phone:607-844-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist