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1336251677 NPI number — PHYLLIS DENISE PENNINGTON-KENT PHD

NPI Number: 1336251677
Health Care Provider/Practitioner: PHYLLIS DENISE PENNINGTON-KENT PHD

Information about “1336251677” NPI (PHYLLIS DENISE PENNINGTON-KENT PHD) exists in 1336251677 in HTML format HTML  |  1336251677 in plain Text format TXT  |  1336251677 in PDF (Portable Document Format) PDF  |  1336251677 in an XML format XML  formats.

NPI Number : 1336251677 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336251677",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PENNINGTON-KENT",
    "FirstName": "PHYLLIS",
    "MiddleName": "DENISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PENNINGTON",
    "OtherFirstName": "PHYLLIS",
    "OtherMiddleName": "DENISE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1201 SOLANO AVE STE 201B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBANY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94706-1753",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-303-0630",
    "MailingAddressFaxNumber": "510-524-8265",
    "FirstLinePracticeLocationAddress": "1201 SOLANO AVE STE 201B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALBANY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94706-1753",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-303-0630",
    "PracticeLocationAddressFaxNumber": "510-234-1982",
    "EnumerationDate": "08/31/2006",
    "LastUpdateDate": "05/10/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103T00000X",
        "TaxonomyName": "Psychologist",
        "LicenseNumber": "PSY16557",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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