Provider Demographics
NPI:1831731520
Name:PENATI, CLARA (LCSWA)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:PENATI
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 HEARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9204
Mailing Address - Country:US
Mailing Address - Phone:604-418-8749
Mailing Address - Fax:
Practice Address - Street 1:3141 JOHN HUMPHRIES WYND STE 275
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7716
Practice Address - Country:US
Practice Address - Phone:919-783-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0141271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical