MEDICARE: MS. SHARON A. PENLAND LCSW-C

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
1	1041C0700X	Clinical Social Worker	01934	MD

General Provider Information

NPI Number	:	1255438156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON A. PENLAND LCSW-C

Provider Business Mailing Address
First Line	:	1618 FARNBORN ST
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1518
Country	:	US
Telephone Number	:	410-721-1573
Fax Number	:	410-721-6389

Provider Business Practice Location Address
First Line	:	1618 FARNBORN ST
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-1518
Country	:	US
Telephone Number	:	410-721-1573
Fax Number	:	410-721-6389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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