Provider Demographics
NPI:1740331644
Name:PENN, PATRICIA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:PENN
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 1:3880 S. BASCOM AVE.,
Mailing Address - Street 2:SUITE 212,
Mailing Address - City:SAN JOSE,
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2675
Mailing Address - Country:US
Mailing Address - Phone:408-377-1200
Mailing Address - Fax:408-377-7833
Practice Address - Street 1:3880 S BASCOM AVE
Practice Address - Street 2:SUITE 212,
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2674
Practice Address - Country:US
Practice Address - Phone:408-377-1200
Practice Address - Fax:408-377-7833
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS116941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical