Provider Demographics
NPI:1811108020
Name:BARBOSA, PENNY M (PHD)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:M
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PENN
Other - Middle Name:M
Other - Last Name:BARBOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-0241
Mailing Address - Country:US
Mailing Address - Phone:530-823-9234
Mailing Address - Fax:530-823-9234
Practice Address - Street 1:10356 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0315
Practice Address - Country:US
Practice Address - Phone:530-823-9234
Practice Address - Fax:530-823-9234
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18949103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical