| Provider / Organization | NPI | Date Certified |
|---|---|---|
| VIDA LYNNE PENN-LEON | 1225150980 | 2024-11-08 |
Vida Lynne Penn-leon is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1225150980. Registration indicates Vida Lynne Penn-leon is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Social Worker (Behavioral Health & Social Service Providers, Social Worker) (Social Worker: Clinical, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Social Worker Clinical, Behavioral Health & Social Service Providers) (Social Worker, ) Access to Mental Health/Behavioral Health Providers (Behavioral Health & Social Service Providers, Social Worker) (Behavioral Health & Social Service Providers, Social Worker) (Social Worker: Clinical, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Social Worker Clinical, Behavioral Health & Social Service Providers) (Social Worker, )
| Entity Type | Individual |
| Provider Name | Mrs. Vida Lynne Penn-leon LCSW-C |
| Practice Office Address | 33 W FRANKLIN ST STE 2 HAGERSTOWN, MD US |
| Practice Office Telephone | 2404579505 |
| Mailing Address | 1401 HAVEN RD APT B12 HAGERSTOWN, MD 217423097 US |
| Business Telephone | 2404579505 |
| Business Fax | 2403378598 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 3900 Westerre Pkwy Ste 300 | Richmond, VA 232331339 | 2404579505 |
| Code | Practice | License No State |
|---|---|---|
| 1041C0700X | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Social Worker Behavioral Health & Social Service Providers Social Worker Social Worker: Clinical Behavioral Health/Substance Abuse/Psychiatry Social Worker Clinical Behavioral Health & Social Service Providers Social Worker | 0904015550
VA |
| 1041C0700X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Social Worker Behavioral Health & Social Service Providers Social Worker Social Worker: Clinical Behavioral Health/Substance Abuse/Psychiatry Social Worker Clinical Behavioral Health & Social Service Providers Social Worker | 10379
MD |
| 193200000X MULT | Group Code |
| 10379 | OTHER | MD | LCSW-C |
| SWB-2024-0703 | OTHER | NM | LCSW-STATE LICE |
| 0904015550 | OTHER | VA | LICENSED CLINIC |