Provider Demographics
NPI:1770791857
Name:PENMAN, GRACE A (LCSW)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:A
Last Name:PENMAN
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 1:1227 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-9432
Mailing Address - Country:US
Mailing Address - Phone:570-594-9615
Mailing Address - Fax:570-784-9240
Practice Address - Street 1:1227 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-9432
Practice Address - Country:US
Practice Address - Phone:570-594-9615
Practice Address - Fax:570-784-9240
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical