Provider Demographics
NPI:1699312751
Name:PENNER, MICHAEL HART (ASW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HART
Last Name:PENNER
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2603
Mailing Address - Country:US
Mailing Address - Phone:415-777-0333
Mailing Address - Fax:
Practice Address - Street 1:170 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2603
Practice Address - Country:US
Practice Address - Phone:415-777-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor