Active NPI
Nicole Penick
- Psychologist
- Valencia, CA
National Provider Identifier
1568003077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 94025009
- Practice address
- 25050 Avenue Kearny
Valencia, CA 91355-1255 - Phone
- (818) 495-8718
- NPI assigned
- Oct 6, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 94025009 | CA | Primary |
Addresses
Primary practice location
25050 Avenue Kearny
Valencia, CA 91355-1255
Mailing address
28649 Placerview TRL
Santa Clarita, CA 91390-5255
Phone (661) 236-2597
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94025009 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570320000000",
"number": "1568003077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28649 PLACERVIEW TRL",
"city": "SANTA CLARITA",
"state": "CA",
"postal_code": "913905255",
"telephone_number": "661-236-2597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25050 AVENUE KEARNY",
"city": "VALENCIA",
"state": "CA",
"postal_code": "913551255",
"telephone_number": "818-495-8718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENICK",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-06",
"last_updated": "2019-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "94025009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valencia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.