Justin David Penner, PhD
Psychologist, Clinical in Bronx, NY. Individual provider (NPI-1).
NPI number1265942007
StatusActive
Last updated in NPPESOct 6, 2017
Details
- NPI
- 1265942007
- Entity type
- Individual (NPI-1)
- Name
- Justin David Penner
- Credential
- PhD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 6, 2017
- Last updated
- Oct 6, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | 021644 | NY | Yes |
Practice location
130 W Kingsbridge RdBronx, NY 10468-3904
Phone 718-584-9000
Mailing address
130 W Kingsbridge RdBronx, NY 10468-3904
Phone 718-584-9000
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