Provider Demographics
NPI:1932449170
Name:PENMER, ANDREW M (MED, BCBA, COBA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:PENMER
Suffix:
Gender:M
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:
Practice Address - Street 1:18151 JEFFERSON PARK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3496
Practice Address - Country:US
Practice Address - Phone:330-967-0325
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-13181103K00000X
OH1-13-13181103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst