MEDICARE: KENDRA PENSKI LICENSED CLINICAL SOCIAL WORKER INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	103T00000X	Psychologist
4	106H00000X	Marriage & Family Therapist
5	133N00000X	Nutritionist
6	133V00000X	Registered Dietitian
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548700891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDRA PENSKI LICENSED CLINICAL SOCIAL WORKER INC

Provider Business Mailing Address
First Line	:	PO BOX 371446
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92137-1446
Country	:	US
Telephone Number	:	619-363-1920
Fax Number	:	619-363-4623

Provider Business Practice Location Address
First Line	:	2254 SAN DIEGO AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2944
Country	:	US
Telephone Number	:	619-363-1920
Fax Number	:	619-363-4623

Authorized Official
Title or Position	:	OWNER
Name	:	KENDRA PENSKI
Credential	:
Telephone Number	:	619-363-1920

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	05/06/2025

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