Provider Demographics
NPI:1114118270
Name:PENSON, ABBY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:
Last Name:PENSON
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 1:11825 MAJOR ST
Mailing Address - Street 2:SUITE #207
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6356
Mailing Address - Country:US
Mailing Address - Phone:323-580-3383
Mailing Address - Fax:323-908-0226
Practice Address - Street 1:11825 MAJOR ST
Practice Address - Street 2:SUITE #207
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6356
Practice Address - Country:US
Practice Address - Phone:323-580-3383
Practice Address - Fax:323-580-3383
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21602103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB221552Medicare PIN