Provider Demographics
NPI:1831415587
Name:PENNINGTON, COLLEEN NOEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:NOEL
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 ORANGE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8025
Mailing Address - Country:US
Mailing Address - Phone:925-206-4745
Mailing Address - Fax:
Practice Address - Street 1:191 SAND CREEK RD
Practice Address - Street 2:SUITE 202 E
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2215
Practice Address - Country:US
Practice Address - Phone:925-642-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist