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General NPI Number Information
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NPI Number | 1366017022
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Entity Type | Individual
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Provider Name | TERENCE MATTHEW PENN PHD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 1501 SULGRAVE AVE
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City | BALTIMORE
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State | MD
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Zip | 21209-3654
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Country | US
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Telephone | 443-708-5856
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Fax | 667-212-5095
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Provider Business Mailing Address
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Address Line | 250 MISSION BLVD UNIT 704
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City | BALTIMORE
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State | MD
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Zip | 21230-5627
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Country | US
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Telephone | 256-541-1609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 07078
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License Number State | MD
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