Provider Demographics
NPI:1336325729
Name:PENNINO, ERICA LEA (PC, CDCA)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LEA
Last Name:PENNINO
Suffix:
Gender:F
Credentials:PC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PRENTISS ST
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1527
Mailing Address - Country:US
Mailing Address - Phone:330-678-3006
Mailing Address - Fax:330-677-7047
Practice Address - Street 1:155 N WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2418
Practice Address - Country:US
Practice Address - Phone:330-678-3006
Practice Address - Fax:330-677-7047
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional