Provider Demographics
NPI:1326340779
Name:PENNELLO, CATHERINE MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARY
Last Name:PENNELLO
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 1:113 HOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3056
Mailing Address - Country:US
Mailing Address - Phone:631-862-6254
Mailing Address - Fax:
Practice Address - Street 1:440 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1406
Practice Address - Country:US
Practice Address - Phone:631-244-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011621-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist