Provider Demographics
NPI:1679772131
Name:PENNEY, STEPHANIE RAQUEL (MA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RAQUEL
Last Name:PENNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 E 29TH ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8264
Mailing Address - Country:US
Mailing Address - Phone:347-266-5170
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:20 SOUTH 17
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program