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NPI Code Detail

MEDICARE: MRS. PENELOPE A CLEVELAND LCSW

MEDICARE: MRS. PENELOPE A CLEVELAND 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 WorkerLCSW #31213TX

General Provider Information

NPI Number : 1487879524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PENELOPE A CLEVELAND LCSW
Provider Business Mailing Address
First Line : 5010 WOODWAY DR APT 715
Second Line :
City : HOUSTON
State : TX
Zip : 77056-1734
Country : US
Telephone Number : 832-202-2297
Fax Number :
Provider Business Practice Location Address
First Line : 310 SUL ROSS ST
Second Line :
City : HOUSTON
State : TX
Zip : 77006-5116
Country : US
Telephone Number : 713-461-7599
Fax Number : 713-463-6661
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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