Healthcare Provider Details

I. General information

NPI: 1275733859
Provider Name (Legal Business Name): JOYCE Y PENN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S HARBOR BLVD STE 100
SANTA ANA CA
92704-7937
US

IV. Provider business mailing address

3601 S HARBOR BLVD STE 100
SANTA ANA CA
92704-7937
US

V. Phone/Fax

Practice location:
  • Phone: 714-223-2600
  • Fax:
Mailing address:
  • Phone: 714-223-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: