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General NPI Number Information
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NPI Number | 1851116081
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Entity Type | Individual
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Provider Name | DAVID PENZO LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 310 E BYRD AVE
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City | BONIFAY
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State | FL
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Zip | 32425-3068
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Country | US
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Telephone | 850-547-5114
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Fax | 850-547-1709
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Provider Business Mailing Address
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Address Line | PO BOX 772
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32435-0772
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Country | US
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Telephone | 850-687-0569
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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 | 23792
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License Number State | FL
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