Provider Demographics
NPI:1346375656
Name:PENSA, ROBERT A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:PENSA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SEMINOLE BLVD
Mailing Address - Street 2:B-112
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-8124
Mailing Address - Country:US
Mailing Address - Phone:727-518-7294
Mailing Address - Fax:727-584-4937
Practice Address - Street 1:1301 SEMINOLE BLVD
Practice Address - Street 2:B-112
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-8124
Practice Address - Country:US
Practice Address - Phone:727-518-7294
Practice Address - Fax:727-584-4937
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59648ZMedicare ID - Type Unspecified