| Pernicano Professional Psychology, Pllc | |
|
8800 Village Drive Ste 209 San Antonio TX 78217 | |
| (210) 202-0100 | |
| (210) 579-9705 |
| Full Name | Pernicano Professional Psychology, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 8800 Village Drive, San Antonio, Texas |
| Authorized Official Name and Position | Kevin Michael Pernicano (OWNER) |
| Authorized Official Contact | 2102784584 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pernicano Professional Psychology, Pllc 8800 Village Drive Ste 209 San Antonio TX 78217 Ph: (210) 202-0100 | Pernicano Professional Psychology, Pllc 8800 Village Drive Ste 209 San Antonio TX 78217 Ph: (210) 202-0100 |
| NPI Number | 1417518556 |
|---|---|
| Provider Enumeration Date | 06/27/2019 |
| Last Update Date | 03/16/2020 |
| Certification Date | 03/16/2020 |
| Medicare PECOS PAC ID | 6305174319 |
|---|---|
| Medicare Enrollment ID | O20190828001771 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417518556 | NPI | - | NPPES |
| 3749426 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kevin M Pernicano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083663835 PECOS PAC ID: 9830382696 Enrollment ID: I20170619002752 |
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