Provider Demographics
NPI:1366823361
Name:PENNINGTON, TESSA GAIL (BA)
Entity type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:GAIL
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 CHETWOOD ST
Mailing Address - Street 2:APT 306
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1461
Mailing Address - Country:US
Mailing Address - Phone:415-623-9678
Mailing Address - Fax:
Practice Address - Street 1:2831 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3649
Practice Address - Country:US
Practice Address - Phone:510-500-5124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst