Individual
JUSTIN DAVID PENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
130 W KINGSBRIDGE RD, BRONX, NY 10468-3904
(718) 584-9000
Mailing address
130 W KINGSBRIDGE RD, BRONX, NY 10468-3904
(718) 584-9000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
021644
NY
Other
Enumeration date
10/06/2017
Last updated
10/06/2017
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