Provider Demographics
NPI:1821301425
Name:PENGEL, MACHTEL M (ASW)
Entity Type:Individual
Prefix:MS
First Name:MACHTEL
Middle Name:M
Last Name:PENGEL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 EL CAMINO REAL
Mailing Address - Street 2:STE 224
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1436
Mailing Address - Country:US
Mailing Address - Phone:650-690-2362
Mailing Address - Fax:650-590-4938
Practice Address - Street 1:150 EXECUTIVE PARK BLVD
Practice Address - Street 2:SUITE 4000
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3303
Practice Address - Country:US
Practice Address - Phone:415-715-1050
Practice Address - Fax:415-715-1051
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 230131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical