Provider Demographics
NPI:1760744999
Name:MUNOZ, PENELOPE
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA FORENSIC PSYCHOLO
Mailing Address - Street 1:16005 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3937
Mailing Address - Country:US
Mailing Address - Phone:516-299-6072
Mailing Address - Fax:516-414-4563
Practice Address - Street 1:265 POST AVE STE 355
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2232
Practice Address - Country:US
Practice Address - Phone:516-299-6072
Practice Address - Fax:516-414-4563
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator