Provider Demographics
NPI:1346625902
Name:PENN, AMBER JUNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:JUNE
Last Name:PENN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:JUNE
Other - Last Name:GORZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:13518 SADDLECREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-1964
Mailing Address - Country:US
Mailing Address - Phone:269-519-4942
Mailing Address - Fax:
Practice Address - Street 1:9208 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1736
Practice Address - Country:US
Practice Address - Phone:502-287-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY263092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program