Gretchen Penner

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

97697 Issued in CA

Practice address

3990 Old Town Ave Ste 209a
San Diego, CA 92110-2967

Phone

(619) 202-5258

NPI assigned

Oct 27, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 18, 2023 through Aug 18, 2027

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 and National Provider Directory roles.

• Therapeutic Center for Anxiety and Trauma, Individual and Family Thera

  • Marriage & Family Therapist
  • San Diego, CA
  • NPI 1770990657
  NPD (past)

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

{
    "created_epoch": "1445904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1942672126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 5TH AVE STE 214",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012139",
            "telephone_number": "619-272-6858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 OLD TOWN AVE STE 209A",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102967",
            "telephone_number": "619-202-5258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNER",
        "first_name": "GRETCHEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-27",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "97697",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW 67771",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivianna Penn
• Zaniecia Penn
• Michael Andre Penna
• Laura Pennelle, LCSW, JD
• Andrew Warren Penner, B.A.
• Jeffrey Penner, PHD
• Nicholas Penner, M.D.
• Nicollette Penner, DPT
• Angela Mariya Penney
• Judith Ann Penniman, LCSW

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.