Individual
BRENT PENQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 S FRONTAGE RD, CHILD STUDY CENTER ATN: TANYA COLON, NEW HAVEN, CT 06519-1124
(203) 737-7129
Mailing address
230 S FRONTAGE RD, CHILD STUDY CENTER ATN: TANYA COLON, NEW HAVEN, CT 06519-1124
(203) 737-7129
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
63784
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2017
Last updated
10/24/2019
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