Provider Demographics
NPI:1013721802
Name:CORMAN PENZEL, SAMUEL (LCSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CORMAN PENZEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MELVIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7407
Mailing Address - Country:US
Mailing Address - Phone:617-990-6877
Mailing Address - Fax:
Practice Address - Street 1:156 LAWTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5801
Practice Address - Country:US
Practice Address - Phone:617-739-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker