Provider Demographics
NPI:1801814744
Name:TIMMEN, PENNY R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:R
Last Name:TIMMEN
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 1:5901 E 7TH ST
Mailing Address - Street 2:BUILDING 150, SCI/D
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:562-826-5718
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:BUILDING 150, SCI/D
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-5718
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992011104100000X, 1041C0700X, 261Q00000X, 261QR0401X, 261QV0200X, 273Y00000X, 282N00000X, 283X00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Not Answered261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
Not Answered273Y00000XHospital UnitsRehabilitation Unit
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered283X00000XHospitalsRehabilitation Hospital
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility