Provider Demographics
NPI:1487879524
Name:CLEVELAND, PENELOPE A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:A
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 WOODWAY DR APT 715
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1734
Mailing Address - Country:US
Mailing Address - Phone:832-202-2297
Mailing Address - Fax:
Practice Address - Street 1:310 SUL ROSS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5116
Practice Address - Country:US
Practice Address - Phone:713-461-7599
Practice Address - Fax:713-463-6661
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW #312131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical