Active NPI
Carol Lee Penn, PH.D.
- Behavior Analyst
- Fresno, CA
National Provider Identifier
1962646539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- PSY 9316
- Practice address
- 1445 W Shaw Ave
Fresno, CA 93711-3608 - Phone
- (559) 222-9512
- NPI assigned
- Apr 28, 2009
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | PSY 9316 | CA | Primary |
Addresses
Primary practice location
1445 W Shaw Ave
Fresno, CA 93711-3608
Mailing address
1445 W Shaw Ave
Fresno, CA 93711-3608
Phone (559) 222-9512
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 |
|---|---|---|---|
| PSY 9316 | CA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240876800000",
"number": "1962646539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1445 W SHAW AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113608",
"telephone_number": "559-222-9512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1445 W SHAW AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113608",
"telephone_number": "559-222-9512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "CAROL",
"middle_name": "LEE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-28",
"last_updated": "2009-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "PSY 9316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.