Provider Demographics
NPI:1891164034
Name:PENRY, LINDA IX
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PENRY
Suffix:IX
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 LOS GAMOS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1835
Mailing Address - Country:US
Mailing Address - Phone:415-457-1925
Mailing Address - Fax:415-457-1929
Practice Address - Street 1:1401 LOS GAMOS DR STE 240
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1835
Practice Address - Country:US
Practice Address - Phone:415-457-1925
Practice Address - Fax:415-457-1929
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor