Provider Demographics
NPI:1063672186
Name:PENNER SMITH, DEBORAH ELINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ELINE
Last Name:PENNER SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ELINE
Other - Last Name:PENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:54 DICKINSON RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-4907
Mailing Address - Country:US
Mailing Address - Phone:973-885-2075
Mailing Address - Fax:
Practice Address - Street 1:54 DICKINSON RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-4907
Practice Address - Country:US
Practice Address - Phone:973-885-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002744001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical