Individual provider Active NPI

Nancy Foster Penn, LCSW

  • Clinical Social Worker
  • Tucker, GA
National Provider Identifier
1053479113
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW002606 Issued in GA
Practice address
3912 Cedar Cir
Tucker, GA 30084-7339
Phone
(770) 414-9742
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW002606 GA Primary

Addresses

Primary practice location

3912 Cedar Cir
Tucker, GA 30084-7339

Mailing address

4378 Sleepy Hollow CV
Lilburn, GA 30047-4196
Phone (770) 279-0785

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070306000497 GA Practitioner - Clinical Social Worker 6800999186 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4228 1St Ave
Suite 7
Tucker, GA 30084-4426
Phone (770) 908-1746

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
View Point Health CurrentSince May 16, 2012 Accepting new patients
Bruce R Penn Inc Clinical CurrentSince Nov 1, 2020 Accepting new patients
J G Options, LLC PastSince Jan 10, 2005 Accepting new patients

Locations

175 Gwinnett Dr
Lawrenceville, GA 30046
Phone (678) 209-2394

4228 1st Ave
Ste 7
Tucker, GA 30084
Phone (770) 908-1746

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053479113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4378 SLEEPY HOLLOW CV",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300474196",
            "telephone_number": "770-279-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3912 CEDAR CIR",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300847339",
            "telephone_number": "770-414-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "NANCY",
        "middle_name": "FOSTER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW002606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

Verify at the official NPI Registry.