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General NPI Number Information
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NPI Number | 1811380884
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Entity Type | Individual
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Provider Name | ANTHONY GEORGE PENNANT JR. LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 211 PARIS AVE STE 1
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City | BROOKLAWN
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State | NJ
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Zip | 08030-2526
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Country | US
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Telephone | 267-997-8744
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Fax |
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Provider Business Mailing Address
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Address Line | 211 PARIS AVE STE 1
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City | BROOKLAWN
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State | NJ
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Zip | 08030-2526
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Country | US
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Telephone | 267-997-8744
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MF000829
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License Number State | PA
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