Healthcare Provider Details

I. General information

NPI: 1801814744
Provider Name (Legal Business Name): PENNY R TIMMEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST BUILDING 150, SCI/D
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST BUILDING 150, SCI/D
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5718
Mailing address:
  • Phone: 562-826-8000
  • Fax: 562-826-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number992011
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number992011
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number992011
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number992011
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number992011
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number992011
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number992011
License Number StateCO
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number992011
License Number StateCO
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992011
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: