Healthcare Provider Details

I. General information

NPI: 1578696555
Provider Name (Legal Business Name): CHERRI E. PENTON PH.D. , M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 01/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 COLLEGE DR
BATON ROUGE LA
70808-1919
US

IV. Provider business mailing address

232 SHADY OAKS CT
BATON ROUGE LA
70810-5349
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-3420
  • Fax: 225-922-9316
Mailing address:
  • Phone: 225-755-6138
  • Fax: 225-755-2573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.1026
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: