Provider Demographics
NPI:1871579284
Name:PENNER, CRAIG ROBERT (MA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ROBERT
Last Name:PENNER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-1649
Mailing Address - Country:US
Mailing Address - Phone:805-965-2287
Mailing Address - Fax:
Practice Address - Street 1:27 E VICTORIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2619
Practice Address - Country:US
Practice Address - Phone:805-966-7794
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17516106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist