Provider Demographics
NPI:1336251677
Name:PENNINGTON-KENT, PHYLLIS DENISE (PHD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:DENISE
Last Name:PENNINGTON-KENT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:DENISE
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 SOLANO AVE STE 201B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1753
Mailing Address - Country:US
Mailing Address - Phone:510-303-0630
Mailing Address - Fax:510-524-8265
Practice Address - Street 1:1201 SOLANO AVE STE 201B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1753
Practice Address - Country:US
Practice Address - Phone:510-303-0630
Practice Address - Fax:510-234-1982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16557103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist