Provider Demographics
NPI:1053479113
Name:PENN, NANCY FOSTER (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:FOSTER
Last Name:PENN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4378 SLEEPY HOLLOW CV
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4196
Mailing Address - Country:US
Mailing Address - Phone:770-279-0785
Mailing Address - Fax:
Practice Address - Street 1:3912 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7339
Practice Address - Country:US
Practice Address - Phone:770-414-9742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical