Pernicano Professional Psychology, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

PERNICANO PROFESSIONAL PSYCHOLOGY, PLLC

Practice address

8800 Village Drive
Ste 209
San Antonio, TX 78217

Phone

(210) 202-0100

Fax

(210) 579-9705

NPI assigned

Jun 27, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Michael Pernicano, PHDNPI 1083663835

Title

Owner

Phone

(210) 278-4584

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Michael Pernicano, PHD

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1083663835
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1417518556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8800 VILLAGE DRIVE",
            "address_2": "STE 209",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78217",
            "telephone_number": "210-202-0100",
            "fax_number": "210-579-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8800 VILLAGE DRIVE",
            "address_2": "STE 209",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78217",
            "telephone_number": "210-202-0100",
            "fax_number": "210-579-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERNICANO PROFESSIONAL PSYCHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-27",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "PERNICANO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-278-4584",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3749426",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriella M Perlinger
• Jeremy Seth Perlman, M.D.
• Kendall Perlwitz, CRNA
• Kevin Tyler Permann, PHARMD
• Senta Pernell, DENTAL HYGIENST
• Pernicano Psychological Services, PLLC
• Kevin Michael Pernicano, PHD
• Abby Marie Perone, D.C.
• Miranda Elyse Perotti, RN IBCLC
• Peter Timothy Perretta, M.D.

• Clinical Psychologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.