Provider Demographics
NPI:1902138811
Name:REED, PENNY (LCSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:REED
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 1:257 VERNON ST APT 307
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4162
Mailing Address - Country:US
Mailing Address - Phone:510-834-8185
Mailing Address - Fax:510-834-8185
Practice Address - Street 1:445 BELLEVUE AVE
Practice Address - Street 2:SUITE 101 RM. B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:510-834-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW254781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical