Provider Demographics
NPI:1881246361
Name:FACHER, PENELOPE JENNIFER (LCSW PHD)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:JENNIFER
Last Name:FACHER
Suffix:
Gender:F
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 556
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1525
Mailing Address - Country:US
Mailing Address - Phone:310-415-2091
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 556
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1525
Practice Address - Country:US
Practice Address - Phone:310-415-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical