Organization
PERNICANO PROFESSIONAL PSYCHOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN MICHAEL PERNICANO PHD (OWNER)
(210) 278-4584
Entity
Organization
Contact information
Practice address
8800 VILLAGE DRIVE, STE 209, SAN ANTONIO, TX 78217
(210) 202-0100
(210) 579-9705
Mailing address
8800 VILLAGE DRIVE, STE 209, SAN ANTONIO, TX 78217
(210) 202-0100
(210) 579-9705
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3749426
—
TX
Enumeration date
06/27/2019
Last updated
03/16/2020
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