Provider Demographics
NPI:1093228074
Name:PENNER, CARLA J (LPCC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:PENNER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:J
Other - Last Name:KASTANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:956 TRIMBLE PL
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2272
Mailing Address - Country:US
Mailing Address - Phone:216-644-6442
Mailing Address - Fax:
Practice Address - Street 1:6909 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2474
Practice Address - Country:US
Practice Address - Phone:440-630-9426
Practice Address - Fax:440-630-9129
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor