Provider Demographics
NPI:1639504665
Name:PENNINGTON, MISTY LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LYNN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 PHILIPSBURG BIGLER HWY
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-8112
Mailing Address - Country:US
Mailing Address - Phone:814-342-5678
Mailing Address - Fax:814-342-0532
Practice Address - Street 1:1633 PHILIPSBURG BIGLER HWY
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8112
Practice Address - Country:US
Practice Address - Phone:814-342-5678
Practice Address - Fax:814-342-0532
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker