| Organization Name: | PENNY BLAZEJ LICENSED CLINICAL SOCIAL WORKER PROF CORP |
| NPI Number: | 1821279043 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PENNY ANNETTE BLAZEJ (OWNER) |
| Mailing Address: | 28714 Valley Center Road Suite E Valley Center |
| State: | CA US |
| Postal Code: | 92082 |
| Phone Number: | 7606853403 |
| Fax Number: | 7607518650 |
| NPI Enumeration Date: | 11/15/2007 |
| NPI Last Update Date: | 11/15/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 21570 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |