Provider Demographics
NPI:1992906861
Name:PENN, ARIELLE LINDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:ARIELLE
Middle Name:LINDA
Last Name:PENN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ARIELLE
Other - Middle Name:LINDA
Other - Last Name:ABERGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5534 SYLMAR AVENUE #1
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:310-892-7435
Mailing Address - Fax:818-989-4356
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:SUITE #420
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:310-892-7435
Practice Address - Fax:818-989-4356
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS21856OtherBOARD OF BEHAVIORAL SCIENCES