Provider Demographics
NPI:1912221706
Name:PENNY, JAMES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:PENNY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4154
Mailing Address - Country:US
Mailing Address - Phone:718-699-9191
Mailing Address - Fax:718-699-0796
Practice Address - Street 1:9515 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4154
Practice Address - Country:US
Practice Address - Phone:718-699-9191
Practice Address - Fax:718-699-0796
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical