Doctor Name: | DR. CANDICE PENNELLA |
NPI Number: | 1194856336 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 017921 |
Business Practice Address: | 1 Hawk Dr Psychological Counseling Center, Hcc New Paltz, NY - 125612447 |
Business Phone Number: | 8452572920 |
Business Fax Number: | |
Mailing Address: | 1 Hawk Dr, Psychological Counseling Center, Hcc NEW PALTZ |
State: | NY |
Postal Code: | 125612447 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/08/2007 |
NPI Last Update Date: | 07/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 017921 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |