Provider Demographics
NPI:1063507093
Name:PENNINGTON, JANICE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:PENNINGTON
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 1:1000 N MORRISON BLVD
Mailing Address - Street 2:STE G2
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401
Mailing Address - Country:US
Mailing Address - Phone:985-542-6736
Mailing Address - Fax:985-542-6736
Practice Address - Street 1:1000 N MORRISON BLVD
Practice Address - Street 2:STE G2
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401
Practice Address - Country:US
Practice Address - Phone:985-542-6736
Practice Address - Fax:985-542-6736
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1904104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B891Medicare ID - Type Unspecified