MEDICARE: LAURIE E PENNINGTON 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	9006	LA

General Provider Information

NPI Number	:	1821142753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE E PENNINGTON LCSW

Provider Business Mailing Address
First Line	:	91 NORTHWEST DR
Second Line	:
City	:	PLAINVILLE
State	:	CT
Zip	:	06062-1534
Country	:	US
Telephone Number	:	203-752-1350
Fax Number	:	203-752-1769

Provider Business Practice Location Address
First Line	:	1435 STATE ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-2702
Country	:	US
Telephone Number	:	203-752-1350
Fax Number	:	203-752-1769

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/27/2007

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Directions to “ LAURIE E PENNINGTON LCSW” Practice Location

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