Provider Demographics
NPI:1457615817
Name:PENNACHIO, HAYLIE JENNA (BS PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:HAYLIE
Middle Name:JENNA
Last Name:PENNACHIO
Suffix:
Gender:F
Credentials:BS PSYCHOLOGY
Other - Prefix:
Other - First Name:HAYLIE
Other - Middle Name:JENNA
Other - Last Name:ROSSINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 ANGELINA COURT
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444
Mailing Address - Country:US
Mailing Address - Phone:805-235-0696
Mailing Address - Fax:
Practice Address - Street 1:508 ANGELINA COURT
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444
Practice Address - Country:US
Practice Address - Phone:805-235-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-30
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health