Organization
PERNICANO PSYCHOLOGICAL SERVICES, PLLC
Active
Organization
PERNICANO PSYCHOLOGICAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA PERNICANO LP (OWNDER)
(502) 649-0697
Entity
Organization
Contact information
Practice address
8800 VILLAGE DR STE 209, SAN ANTONIO, TX 78217-5420
(210) 202-0100
Mailing address
8800 VILLAGE DR STE 209, SAN ANTONIO, TX 78217-5420
(210) 202-0100
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200878100
—
IN
Enumeration date
02/22/2020
Last updated
02/22/2020
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