Active NPI
Frederick W. Penza, ED.D.
- Health Service Psychologist
- Andover, MA
National Provider Identifier
1720143381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Psychologist
- License
- 871
- Practice address
- 6 Enfield Dr
Andover, MA 01810-6021 - Phone
- (978) 475-6169
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | 871 | MA | Primary |
Addresses
Primary practice location
6 Enfield Dr
Andover, MA 01810-6021
Mailing address
6 Enfield Dr
Andover, MA 01810-6021
Phone (978) 475-6169
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0505366 | Medicaid | MA | |
| WO1265 | Other | MA | BCBS PROVIDER NUMBER |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1720143381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 ENFIELD DR",
"city": "ANDOVER",
"state": "MA",
"postal_code": "018106021",
"telephone_number": "978-475-6169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 ENFIELD DR",
"city": "ANDOVER",
"state": "MA",
"postal_code": "018106021",
"telephone_number": "978-475-6169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENZA",
"first_name": "FREDERICK",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "MA",
"license": "871",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0505366",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "WO1265",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Andover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.