MEDICARE: DR. COLLEEN NOEL PENNINGTON PSY.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	103T00000X	Psychologist	PSY22533	CA

General Provider Information

NPI Number	:	1831415587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN NOEL PENNINGTON PSY.D.

Provider Business Mailing Address
First Line	:	2630 ORANGE WAY
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94531-8025
Country	:	US
Telephone Number	:	925-206-4745
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 SAND CREEK RD
Second Line	:	SUITE 202 E
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2215
Country	:	US
Telephone Number	:	925-642-1987
Fax Number	:

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

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	12/31/2013

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