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NPI Code Detail

MEDICARE: MS. MARY PENN LCSW

MEDICARE: MS. MARY PENN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker65541CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104253798
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY PENN LCSW
Provider Business Mailing Address
First Line : 564 6TH ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-4708
Country : US
Telephone Number : 415-241-4266
Fax Number : 415-241-4201
Provider Business Practice Location Address
First Line : 564 6TH ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-4708
Country : US
Telephone Number : 415-241-4266
Fax Number : 415-241-4201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2013
Last Update Date : 02/18/2015

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