Individual
DR. KEVIN MICHAEL PERNICANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
8800 VILLAGE DRIVE, STE 209, SAN ANTONIO, TX 78217
(210) 202-0100
(210) 579-9705
Mailing address
2071 WIND CHIME WAY, NEW BRAUNFELS, TX 78130
(210) 278-4584
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
37643
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3749426
—
TX
01
—
37643
TEXAS STATE PSYCHOLOGY LICENSE
TX
Enumeration date
05/09/2006
Last updated
03/16/2020
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