Provider Demographics
NPI:1558664631
Name:PENNY LANE
Entity Type:Organization
Organization Name:PENNY LANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILINGUAL OUTPATIENT THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:JOSEFINA
Authorized Official - Last Name:YANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:323-318-9960
Mailing Address - Street 1:15317 RAYEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5117
Mailing Address - Country:US
Mailing Address - Phone:818-892-3423
Mailing Address - Fax:818-893-4509
Practice Address - Street 1:2450 S ATLANTIC BLVD
Practice Address - Street 2:SUITE # 101
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1200
Practice Address - Country:US
Practice Address - Phone:323-318-9960
Practice Address - Fax:323-780-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health