Provider Demographics
NPI:1225389596
Name:CHRIS PENTA, PSY.D., LLC
Entity Type:Organization
Organization Name:CHRIS PENTA, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PENTA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-285-8270
Mailing Address - Street 1:46 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2909
Mailing Address - Country:US
Mailing Address - Phone:860-285-8270
Mailing Address - Fax:
Practice Address - Street 1:46 COURT ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2909
Practice Address - Country:US
Practice Address - Phone:860-285-8270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002378103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty