Provider Demographics
NPI:1295526788
Name:SAMUELS, PENNY (LGSW)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW
Mailing Address - Street 1:1436 U ST NW STE 401
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3988
Mailing Address - Country:US
Mailing Address - Phone:513-313-1374
Mailing Address - Fax:
Practice Address - Street 1:1436 U ST NW STE 401
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3988
Practice Address - Country:US
Practice Address - Phone:513-313-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50079565104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty