Provider Demographics
NPI:1578972758
Name:CREMEN, PENNI (MFT)
Entity Type:Individual
Prefix:
First Name:PENNI
Middle Name:
Last Name:CREMEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PENNI
Other - Middle Name:JACOBSON
Other - Last Name:CREMEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2180 JEFFERSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1249
Mailing Address - Country:US
Mailing Address - Phone:707-483-9321
Mailing Address - Fax:
Practice Address - Street 1:2180 JEFFERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1249
Practice Address - Country:US
Practice Address - Phone:707-483-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist