Provider Demographics
NPI:1770714214
Name:DOUGLAS-PENN, CATHERINE (LISW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DOUGLAS-PENN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4297
Mailing Address - Country:US
Mailing Address - Phone:513-874-9460
Mailing Address - Fax:513-636-4283
Practice Address - Street 1:5502 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4297
Practice Address - Country:US
Practice Address - Phone:513-874-9460
Practice Address - Fax:513-636-4283
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0003444-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical