Provider Demographics
NPI:1396123634
Name:MASSOTH-BECKMAN, PENNY (PSYD)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:
Last Name:MASSOTH-BECKMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PENNY
Other - Middle Name:MASSOTH
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:144 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2314
Mailing Address - Country:US
Mailing Address - Phone:917-922-0082
Mailing Address - Fax:
Practice Address - Street 1:333 WESTCHESTER AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2910
Practice Address - Country:US
Practice Address - Phone:914-328-2868
Practice Address - Fax:914-328-2973
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY954675991103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool