Healthcare Provider Details

I. General information

NPI: 1275740227
Provider Name (Legal Business Name): PENELOPE L NORTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W GRANADA BLVD STE. E3
ORMOND BEACH FL
32174-9485
US

IV. Provider business mailing address

555 W GRANADA BLVD STE. E3
ORMOND BEACH FL
32174-9485
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-5420
  • Fax:
Mailing address:
  • Phone: 386-676-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3198
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY3198
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY3198
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPY3198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: