Active NPI
Terence Matthew Penn, PHD
- Clinical Psychologist
- Baltimore, MD
National Provider Identifier
1366017022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 07078
- Practice address
- 1501 Sulgrave Ave
Baltimore, MD 21209-3654 - Phone
- (443) 708-5856
- Fax
- (667) 212-5095
- NPI assigned
- May 25, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 07078 | MD | Primary |
Addresses
Primary practice location
1501 Sulgrave Ave
Baltimore, MD 21209-3654
Mailing address
250 Mission Blvd Unit 704
Baltimore, MD 21230-5627
Phone (256) 541-1609
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
| License | State | Type | Specialty |
|---|---|---|---|
| 07078 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731974400000",
"number": "1366017022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 MISSION BLVD UNIT 704",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212305627",
"telephone_number": "256-541-1609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 SULGRAVE AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212093654",
"telephone_number": "443-708-5856",
"fax_number": "667-212-5095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "TERENCE",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-25",
"last_updated": "2024-11-19",
"certification_date": "2024-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "07078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.