Provider Demographics
NPI:1184731044
Name:CRONIN, PEGEEN MARY (PHD)
Entity type:Individual
Prefix:
First Name:PEGEEN
Middle Name:MARY
Last Name:CRONIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1723
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-1723
Mailing Address - Country:US
Mailing Address - Phone:877-428-8478
Mailing Address - Fax:877-428-8478
Practice Address - Street 1:1802 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7701
Practice Address - Country:US
Practice Address - Phone:877-428-8478
Practice Address - Fax:877-428-8478
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16026103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY160260Medicaid
CAPSY160260Medicaid
CAP05608Medicare UPIN