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General NPI Number Information
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NPI Number | 1134498777
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Entity Type | Individual
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Provider Name | LISA ANNE PENNY M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 13160 MINDANAO WAY #300
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6358
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Country | US
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Telephone | 310-990-9164
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Fax | 310-306-8018
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Provider Business Mailing Address
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Address Line | 4241 VIA MARINA #501K
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5242
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Country | US
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Telephone | 310-990-9164
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Fax | 310-306-8018
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 79290
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License Number State | CA
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