Provider Demographics
NPI:1528502614
Name:PENALVERT, HADIL (LCSW)
Entity type:Individual
Prefix:MS
First Name:HADIL
Middle Name:
Last Name:PENALVERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HADIL
Other - Middle Name:
Other - Last Name:MOGHNIEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 E 4TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3916
Mailing Address - Country:US
Mailing Address - Phone:949-735-6422
Mailing Address - Fax:
Practice Address - Street 1:2001 E 4TH ST STE 116
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3916
Practice Address - Country:US
Practice Address - Phone:949-735-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041541041C0700X
CA74756104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96-4079133OtherTAXPAYER IDENTIFICATION NUMBER