Provider Demographics
NPI:1710221031
Name:PENUEL, AMBER K (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:K
Last Name:PENUEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10776 GRAYS CORNER RD.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-213-7875
Mailing Address - Fax:410-213-7877
Practice Address - Street 1:10776 GRAYS CORNER RD.
Practice Address - Street 2:SUITE 2
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-213-7875
Practice Address - Fax:410-213-7877
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05296103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical