Active NPI
Kathleen Ingham Pennoyer, PH.D.
- Clinical Psychologist
- Peabody, MA
National Provider Identifier
1407914179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7663
- Practice address
- 5 Essex Green Dr
Ste 22
Peabody, MA 01960-2914 - Phone
- (978) 682-1579
- Fax
- (978) 689-4852
- NPI assigned
- Dec 5, 2006
- Last updated
- Jun 14, 2019
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7663 | MA | Primary |
Addresses
Primary practice location
5 Essex Green Dr
Ste 22
Peabody, MA 01960-2914
Mailing address
5 Essex Green Dr Ste 22
Peabody, MA 01960-2914
Phone (978) 338-3001
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7663 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560470400000",
"number": "1407914179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 ESSEX GREEN DR STE 22",
"city": "PEABODY",
"state": "MA",
"postal_code": "019602914",
"telephone_number": "978-338-3001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 ESSEX GREEN DR",
"address_2": "STE 22",
"city": "PEABODY",
"state": "MA",
"postal_code": "019602914",
"telephone_number": "978-682-1579",
"fax_number": "978-689-4852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNOYER",
"first_name": "KATHLEEN",
"middle_name": "INGHAM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2019-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peabody, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.