Provider Demographics
NPI:1588909782
Name:PENNEY, DAWN M (BC-DMT, LPC, CCTP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:PENNEY
Suffix:
Gender:F
Credentials:BC-DMT, LPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-3306
Mailing Address - Country:US
Mailing Address - Phone:312-550-9497
Mailing Address - Fax:
Practice Address - Street 1:403 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-3306
Practice Address - Country:US
Practice Address - Phone:312-550-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006605101YP2500X
225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
27-2821161OtherEIN