Provider Demographics
NPI:1306997549
Name:GEORGE, PENNY CHERYL (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:CHERYL
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 CATALPHA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2528
Mailing Address - Country:US
Mailing Address - Phone:410-254-4868
Mailing Address - Fax:410-254-0616
Practice Address - Street 1:5710 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3606
Practice Address - Country:US
Practice Address - Phone:410-218-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical