Provider Demographics
NPI:1073054987
Name:PENNYWELL, JOSLYN
Entity type:Individual
Prefix:MISS
First Name:JOSLYN
Middle Name:
Last Name:PENNYWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 SEPULVEDA BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-5427
Mailing Address - Country:US
Mailing Address - Phone:318-548-5048
Mailing Address - Fax:
Practice Address - Street 1:15021 VENTURA BLVD STE 332
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2442
Practice Address - Country:US
Practice Address - Phone:818-570-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008331360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health