Provider Demographics
NPI:1912117417
Name:NECKOWITZ, PENELOPE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:
Last Name:NECKOWITZ
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 1:10 ORCHARD VW
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9236
Mailing Address - Country:US
Mailing Address - Phone:610-388-2622
Mailing Address - Fax:
Practice Address - Street 1:544 KENNETT PIKE
Practice Address - Street 2:UNIT 2
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9384
Practice Address - Country:US
Practice Address - Phone:610-388-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005671L103T00000X
DEB1-0000261103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist