Provider Demographics
NPI:1063414068
Name:PENNINGTON, MARGARET S (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:S
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3861 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4646
Mailing Address - Country:US
Mailing Address - Phone:520-325-8500
Mailing Address - Fax:520-325-3424
Practice Address - Street 1:3861 E 3RD ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4646
Practice Address - Country:US
Practice Address - Phone:520-325-8500
Practice Address - Fax:520-325-3424
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPHD587AMedicare ID - Type Unspecified