Provider Demographics
NPI:1063896652
Name:TOMAN, PENNY IRENE (MSW, LCSW, CCM)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:IRENE
Last Name:TOMAN
Suffix:
Gender:F
Credentials:MSW, LCSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W FEE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4476
Mailing Address - Country:US
Mailing Address - Phone:321-795-0738
Mailing Address - Fax:321-951-3987
Practice Address - Street 1:21 W FEE AVE STE C
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-795-0738
Practice Address - Fax:321-951-3987
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW137691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical