Active NPI
Elizabeth Penn, PSYD
- Psychologist
- Bronx, NY
National Provider Identifier
1356867154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 022261
- Practice address
- 3600 Fieldston Rd Apt 2K
Bronx, NY 10463-2007 - Phone
- (914) 839-8149
- NPI assigned
- Aug 14, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 022261 | NY | Primary |
Addresses
Primary practice location
3600 Fieldston Rd Apt 2K
Bronx, NY 10463-2007
Mailing address
1273 North Ave
3A5
New Rochelle, NY 10804
Phone (347) 524-2762
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022261 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502668800000",
"number": "1356867154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1273 NORTH AVE",
"address_2": "3A5",
"city": "NEW ROCHELLE",
"state": "NY",
"postal_code": "10804",
"telephone_number": "347-524-2762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 FIELDSTON RD APT 2K",
"city": "BRONX",
"state": "NY",
"postal_code": "104632007",
"telephone_number": "914-839-8149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-14",
"last_updated": "2017-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "022261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.