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NPI Code Detail

MEDICARE: MRS. DORETHA FRANCINE PENGEL LCSW

MEDICARE: MRS. DORETHA FRANCINE PENGEL 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
1104100000XSocial Worker071865-1NY
21041C0700XClinical Social Worker088747NY
31041C0700XClinical Social Worker69298TX

General Provider Information

NPI Number : 1205156809
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DORETHA FRANCINE PENGEL LCSW
Provider Business Mailing Address
First Line : 13810 CHAMPION FOREST DR STE 150
Second Line :
City : HOUSTON
State : TX
Zip : 77069-1883
Country : US
Telephone Number : 832-639-8080
Fax Number :
Provider Business Practice Location Address
First Line : 13810 CHAMPION FOREST DR STE 150
Second Line :
City : HOUSTON
State : TX
Zip : 77069-1883
Country : US
Telephone Number : 832-639-8080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2010
Last Update Date : 01/23/2021

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