Individual provider Active NPI

Patricia Penn, PH.D.

  • Psychologist
  • Tucson, AZ
National Provider Identifier
1164552386
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1959 Issued in AZ
Practice address
502 W 29TH St
Tucson, AZ 85713-3353
Phone
(520) 884-9920
Fax
(520) 792-0654
NPI assigned
Mar 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Psychologist 103TA0400X 1959 AZ
Adult Development & Aging Psychologist 103TA0700X 1959 AZ
Cognitive & Behavioral Psychologist 103TB0200X 1959 AZ
Clinical Psychologist 103TC0700X 1959 AZ
Counseling Psychologist 103TC1900X 1959 AZ
Family Psychologist 103TF0000X 1959 AZ
Group Psychotherapy Psychologist 103TP2701X 1959 AZ
Psychologist 103T00000X 1959 AZ Primary

Addresses

Primary practice location

502 W 29TH St
Tucson, AZ 85713-3353

Mailing address

502 W 29TH St
Tucson, AZ 85713-3353
Phone (520) 884-9920

Other identifiers 1

IdentifierTypeStateIssuer
505191MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
1959AZMDAddiction (Substance Use Disorder) Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1164552386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 W 29TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857133353",
            "telephone_number": "520-884-9920",
            "fax_number": "520-792-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W 29TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857133353",
            "telephone_number": "520-884-9920",
            "fax_number": "520-792-0654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "PATRICIA",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "1959",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "AZ",
            "license": "1959",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "AZ",
            "license": "1959",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "1959",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "AZ",
            "license": "1959",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "AZ",
            "license": "1959",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "AZ",
            "license": "1959",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "1959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "505191",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.