MEDICARE: DR. ELIZABETH CARNEL PENICK PHD, ABPP

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	103T00000X	Psychologist	0544	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11478022	OTHER	MO	BCBS KANSAS CITY

General Provider Information

NPI Number	:	1659480952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH CARNEL PENICK PHD, ABPP

Provider Business Mailing Address
First Line	:	3901 RAINBOW BOULEVARD
Second Line	:	4070 DELP, MAIL STOP 4017
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-7816
Country	:	US
Telephone Number	:	913-588-6463
Fax Number	:	913-588-6414

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	DEPT OF PSYCHIATRY & BEHAVIORAL SCIENCES
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-7341
Country	:	US
Telephone Number	:	913-588-6463
Fax Number	:	913-588-6414

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/09/2007

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