Healthcare Provider Details

I. General information

NPI: 1053947424
Provider Name (Legal Business Name): GIANNINA MIXCO PENNISI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GIANNINA MIXCO

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE PARK AVENUE
NEW YORK NY
10016
US

IV. Provider business mailing address

ONE PARK AVENUE
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-5000
  • Fax: 646-754-9538
Mailing address:
  • Phone: 646-754-5000
  • Fax: 646-754-9538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: