Healthcare Provider Details

I. General information

NPI: 1386278935
Provider Name (Legal Business Name): PERNICANO PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 VILLAGE DR STE 209
SAN ANTONIO TX
78217-5420
US

IV. Provider business mailing address

8800 VILLAGE DR STE 209
SAN ANTONIO TX
78217-5420
US

V. Phone/Fax

Practice location:
  • Phone: 210-202-0100
  • Fax:
Mailing address:
  • Phone: 210-202-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA PERNICANO
Title or Position: OWNDER
Credential: LP
Phone: 502-649-0697