Provider Demographics
NPI:1659480952
Name:PENICK, ELIZABETH CARNEL (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CARNEL
Last Name:PENICK
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BOULEVARD
Mailing Address - Street 2:4070 DELP, MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-7816
Mailing Address - Country:US
Mailing Address - Phone:913-588-6463
Mailing Address - Fax:913-588-6414
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:DEPT OF PSYCHIATRY & BEHAVIORAL SCIENCES
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7341
Practice Address - Country:US
Practice Address - Phone:913-588-6463
Practice Address - Fax:913-588-6414
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0544103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11478022OtherBCBS KANSAS CITY
KS0615081AMedicare ID - Type Unspecified
MO11478022OtherBCBS KANSAS CITY