Provider Demographics
NPI:1326177957
Name:PIGMAN, PENELOPE (MSW)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:
Last Name:PIGMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53950 VAN DYKE AVE
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1819
Mailing Address - Country:US
Mailing Address - Phone:586-778-9276
Mailing Address - Fax:
Practice Address - Street 1:53950 VAN DYKE AVE
Practice Address - Street 2:SUITE 210B
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-1819
Practice Address - Country:US
Practice Address - Phone:586-781-8400
Practice Address - Fax:586-781-8300
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801059240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical