MEDICARE: PENNY LANE CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	251B00000X	Case Management Agency	CA
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1881793313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNY LANE CENTERS

Provider Business Mailing Address
First Line	:	10526 DUBNOFF WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3921
Country	:	US
Telephone Number	:	818-894-3384
Fax Number	:

Provider Business Practice Location Address
First Line	:	15305 RAYEN ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-5117
Country	:	US
Telephone Number	:	818-892-3423
Fax Number	:	818-892-3574

Authorized Official
Title or Position	:	SR DIR OF BEHAVIORAL HEALTH SERVICE
Name	:	MS. KRISTIN MALKA
Credential	:	M.A., LMFT
Telephone Number	:	818-892-3423

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/12/2023

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Directions to “PENNY LANE CENTERS ” Practice Location

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