Healthcare Provider Details

I. General information

NPI: 1821163999
Provider Name (Legal Business Name): FREDERICK JAMES PENNEY M.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N FRONT ST
NEW BEDFORD MA
02740-7350
US

IV. Provider business mailing address

13 E GROVE ST
MIDDLEBORO MA
02346-1826
US

V. Phone/Fax

Practice location:
  • Phone: 508-994-0885
  • Fax: 508-997-0765
Mailing address:
  • Phone: 508-946-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: