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General NPI Number Information
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NPI Number | 1649454901
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Entity Type | Individual
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Provider Name | MIKEL-CLAIRE ALEXANDRIA PENICK MSW
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Gender | Female
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 6957 N FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90042-1245
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Country | US
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Telephone | 323-443-3137
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 KLUMP AVE APT 213
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-5010
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Country | US
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Telephone | 404-314-9042
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW 23175
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License Number State | CA
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