Healthcare Provider Details

I. General information

NPI: 1952764060
Provider Name (Legal Business Name): PENELOPE L. NORTON, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
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
32174-9401
US

IV. Provider business mailing address

555 W GRANADA BLVD STE E3
ORMOND BEACH FL
32174-9401
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 TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY0003198
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY0003198
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPY0003198
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0003198
License Number StateFL

VIII. Authorized Official

Name: MRS. BECKY MOREY
Title or Position: OFFICE MANAGER
Credential:
Phone: 386-676-5420