1457615817 NPI number — HAYLIE JENNA PENNACHIO B.S. PSYCHOLOGY

Table of content: HAYLIE JENNA PENNACHIO B.S. PSYCHOLOGY (NPI 1457615817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457615817 NPI number — HAYLIE JENNA PENNACHIO B.S. PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENNACHIO
Provider First Name:
HAYLIE
Provider Middle Name:
JENNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.S. PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSSINI
Provider Other First Name:
HAYLIE
Provider Other Middle Name:
JENNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457615817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 ANGELINA COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIPOMO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-235-0696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 ANGELINA COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIPOMO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-235-0696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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