Provider Demographics
NPI:1821776618
Name:PENBERG, NICOLE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:PENBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:PENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:145 44TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-3038
Mailing Address - Country:US
Mailing Address - Phone:412-710-6577
Mailing Address - Fax:
Practice Address - Street 1:322 N SHORE DR BLDG 1B
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5875
Practice Address - Country:US
Practice Address - Phone:646-453-6777
Practice Address - Fax:212-337-9841
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional