Individual
DR. FREDERICK W. PENZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
6 ENFIELD DR, ANDOVER, MA 01810-6021
(978) 475-6169
Mailing address
6 ENFIELD DR, ANDOVER, MA 01810-6021
(978) 475-6169
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
871
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0505366
—
MA
01
—
WO1265
BCBS PROVIDER NUMBER
MA
Enumeration date
12/26/2006
Last updated
07/09/2007
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