Provider Demographics
NPI:1972655959
Name:PENFIELD, JOAN MARIE (LMSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:PENFIELD
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 UNIVERSITY PARK
Mailing Address - Street 2:#375
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6902
Mailing Address - Country:US
Mailing Address - Phone:517-347-4181
Mailing Address - Fax:517-347-7571
Practice Address - Street 1:2145 UNIVERSITY PARK
Practice Address - Street 2:#375
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6902
Practice Address - Country:US
Practice Address - Phone:517-347-4181
Practice Address - Fax:517-347-7571
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801002116104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI037935OtherVALUE OPTIONS
MI87726OtherUBH
MI0891203Medicare ID - Type Unspecified