MEDICARE: KENDRA PENSKI 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
1	1041C0700X	Clinical Social Worker	27142	CA

General Provider Information

NPI Number	:	1639363526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA PENSKI LCSW

Provider Business Mailing Address
First Line	:	3737 MORAGA AVE STE A203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5491
Country	:	US
Telephone Number	:	619-363-1920
Fax Number	:	619-363-4623

Provider Business Practice Location Address
First Line	:	3737 MORAGA AVE STE A203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5491
Country	:	US
Telephone Number	:	619-363-1920
Fax Number	:	619-363-4623

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	04/09/2020

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