Provider Demographics
NPI:1700343464
Name:PENNISI, LEONARD R (LMSW)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:R
Last Name:PENNISI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SAULINO CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1556
Mailing Address - Country:US
Mailing Address - Phone:313-842-7071
Mailing Address - Fax:313-842-5150
Practice Address - Street 1:6451 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2212
Practice Address - Country:US
Practice Address - Phone:313-945-8138
Practice Address - Fax:313-624-9418
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011092221041C0700X
MI68011024531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical