Provider Demographics
NPI:1649200593
Name:PENGILLY, KARMEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARMEL
Middle Name:
Last Name:PENGILLY
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 1:7610 RUSH RIVER DR
Mailing Address - Street 2:#115
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5516
Mailing Address - Country:US
Mailing Address - Phone:916-429-0284
Mailing Address - Fax:
Practice Address - Street 1:1330 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5805
Practice Address - Country:US
Practice Address - Phone:916-443-5707
Practice Address - Fax:916-443-5707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18449103T00000X
MNLP0188103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL184490Medicare ID - Type Unspecified