Penelope Emma Avalos, M.S.W., L.C.S.W

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

009556 Issued in CT

Practice address

567 Vauxhall Street Ext Ste 122
Waterford, CT 06385-4332

Phone

(860) 917-0790

Fax

(860) 371-2624

NPI assigned

Aug 16, 2022

Last updated

Aug 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Inner Peace CT

  • Clinical Social Worker
  • Waterford, CT
  • NPI 1710228036
  NPD (past)

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1114645108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 VAUXHALL STREET EXT STE 122",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063854332",
            "telephone_number": "860-917-0790",
            "fax_number": "860-371-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 VAUXHALL STREET EXT STE 122",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063854332",
            "telephone_number": "860-917-0790",
            "fax_number": "860-371-2624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVALOS",
        "first_name": "PENELOPE",
        "middle_name": "EMMA",
        "credential": "M.S.W., L.C.S.W",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "009556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachelle Andre, MD
• Arlene B. Werner, PH.D.
• Arnold E. Benak Jr. DMD LLC
• Ascension Naturopathic Healing Center LLC
• Amandeep Singh Aujla, M.D.
• Lisa Jane Ballint, LCSW, LADC
• Gary Jules Bango
• Marjorie Wood Barndt, D.M.D., MDSC
• Jennifer Eve Bartholomew, PT
• Jessie R Baudner, ANP BC

• Clinical Social Worker in Waterford, CT
• Providers in Waterford, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.