Provider Demographics
NPI:1629338850
Name:SELLITTO-PENOZA, JENNIFER A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:SELLITTO-PENOZA
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 1:15 ANGOLA RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3518
Mailing Address - Country:US
Mailing Address - Phone:302-598-6542
Mailing Address - Fax:
Practice Address - Street 1:15 ANGOLA RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3518
Practice Address - Country:US
Practice Address - Phone:302-598-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00011541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical