Provider Demographics
NPI:1477854719
Name:PENN, RACHEL HETLER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:HETLER
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:PO BOX 1604
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70044-2421
Mailing Address - Country:US
Mailing Address - Phone:504-278-4006
Mailing Address - Fax:504-278-4007
Practice Address - Street 1:2626 CHARLES DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-3779
Practice Address - Country:US
Practice Address - Phone:504-278-4006
Practice Address - Fax:504-278-4007
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA89571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical