Provider Demographics
NPI:1760524151
Name:PENTA, KAREN A NN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A NN
Last Name:PENTA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2229
Mailing Address - Country:US
Mailing Address - Phone:774-289-4203
Mailing Address - Fax:
Practice Address - Street 1:947 ROUTE 6A STE 11
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2171
Practice Address - Country:US
Practice Address - Phone:617-803-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMALMHC1420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health