Provider Demographics
NPI:1649841768
Name:PENN, ZACHARY (LPCA)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:PENN
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LOWER RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3304
Mailing Address - Country:US
Mailing Address - Phone:203-907-5292
Mailing Address - Fax:
Practice Address - Street 1:4 GROVE BEACH RD N
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1656
Practice Address - Country:US
Practice Address - Phone:203-437-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health