Provider Demographics
NPI:1194951780
Name:PENNINGTON, DYAN L (LICSW)
Entity type:Individual
Prefix:
First Name:DYAN
Middle Name:L
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BRIDGE STREET, P.O. BOX 565
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MA
Mailing Address - Zip Code:01083
Mailing Address - Country:US
Mailing Address - Phone:413-219-0239
Mailing Address - Fax:
Practice Address - Street 1:96 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1616
Practice Address - Country:US
Practice Address - Phone:413-967-6241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300010OtherMBHP
MA1300881Medicaid