Healthcare Provider Details

I. General information

NPI: 1619083532
Provider Name (Legal Business Name): SARALIE B PENNINGTON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4093 24TH ST
SAN FRANCISCO CA
94114-3715
US

IV. Provider business mailing address

4093 24TH ST
SAN FRANCISCO CA
94114-3715
US

V. Phone/Fax

Practice location:
  • Phone: 415-550-2413
  • Fax: 415-239-8535
Mailing address:
  • Phone: 415-550-2413
  • Fax: 415-239-8535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW4116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: