Healthcare Provider Details

I. General information

NPI: 1598755670
Provider Name (Legal Business Name): PENELOPE J TRIEB CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HACKETT BLVD
ALBANY NY
12209-1750
US

IV. Provider business mailing address

66 HACKETT BLVD
ALBANY NY
12209-1750
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4439
  • Fax: 518-262-2196
Mailing address:
  • Phone: 518-262-4439
  • Fax: 518-262-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number044993
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: