=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306997549
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PENNY CHERYL GEORGE LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5710 NEWBURY ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-218-9779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4913 CATALPHA RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21214-2528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-254-4868
-----------------------------------------------------
Fax | 410-254-0616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10049
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------