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Organization
PENNY BLAZEJ LICENSED CLINICAL SOCIAL WORKER PROF CORP
Active
Organization
PENNY BLAZEJ LICENSED CLINICAL SOCIAL WORKER PROF CORP
Active
Parent organization
PENNY BLAZEJ LICENSED CLINICAL SOCIAL WORKER PROF CORP
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENNY BLAZEJ LICENSED CLINICAL SOCIAL WORKER PROF CORP
Authorized official
MRS. PENNY ANNETTE BLAZEJ LCSW BCD (OWNER)
(760) 685-3403
Entity
Organization
Contact information
Practice address
28714 VALLEY CENTER ROAD, SUITE E, VALLEY CENTER, CA 92082
(760) 685-3403
(760) 751-8650
Mailing address
28714 VALLEY CENTER ROAD, SUITE E, VALLEY CENTER, CA 92082
(760) 685-3403
(760) 751-8650
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
21570
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LC5215700
BLUE CROSS BLUE SHIELD
—
Enumeration date
11/15/2007
Last updated
11/15/2007
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