Provider Demographics
NPI:1750542841
Name:ANDRADE, PENELOPE YOUNG (LCSW)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:YOUNG
Last Name:ANDRADE
Suffix:
Gender:F
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:PO BOX 721831
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92172-1831
Mailing Address - Country:US
Mailing Address - Phone:858-481-5752
Mailing Address - Fax:858-484-8374
Practice Address - Street 1:118B ACACIA AVE
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1804
Practice Address - Country:US
Practice Address - Phone:858-481-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALZ11790104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker