MEDICARE: DR. ABBY PENSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY21602	CA

General Provider Information

NPI Number	:	1114118270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABBY PENSON PH.D.

Provider Business Mailing Address
First Line	:	11825 MAJOR ST
Second Line	:	SUITE #207
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6356
Country	:	US
Telephone Number	:	323-580-3383
Fax Number	:	323-908-0226

Provider Business Practice Location Address
First Line	:	11825 MAJOR ST
Second Line	:	SUITE #207
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6356
Country	:	US
Telephone Number	:	323-580-3383
Fax Number	:	323-580-3383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	10/20/2016

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