GRETCHEN PENNER
NPI 1942672126
Social Worker - Clinical in San Diego, CA

Active since October 27, 2015Opted out of Medicare · through Aug 18, 2027
3990 OLD TOWN AVE STE 209A, SAN DIEGO, CA 92110(619) 202-5258 Get Directions Write a Review

NPPES record last updated: January 26, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jan 26, 2022, Mar 17, 2018 (2 updates tracked since 2018).

About Gretchen Penner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRETCHEN PENNER (NPI 1942672126) is an individual clinical provider in San Diego, California, licensed in California (97697) and active in the NPI registry since October 2015. She has opted out of Medicare through August 18, 2027.

NPPES Registry Identity

NPI1942672126
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameGRETCHEN PENNER
Location Address3990 OLD TOWN AVE STE 209ASan Diego, CA 92110-2967
Mailing Address2121 5th Ave Ste 214San Diego, CA 92101-2139 · (619) 272-6858
Sole ProprietorYes
Enumeration DateOctober 27, 2015
Last NPPES UpdateJanuary 26, 20222 updates tracked since enumeration
NPPES CertifiedJanuary 26, 2022
NPI 1942672126 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in CA · 97697
Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedSocial WorkerTaxonomy 104100000X · License ASW 67771 (CA)
3990 OLD TOWN AVE STE 209A, San Diego, CA 92110

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Gretchen Penner has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from August 18, 2023 through August 18, 2027.

Opt-Out Effective DateAugust 18, 2023
Opt-Out In Effect ThroughAugust 18, 2027Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1942672126, enumerated as an "individual" on October 27, 2015.

The provider is located at 3990 OLD TOWN AVE STE 209A SAN DIEGO, CA 92110 and the phone number is (619) 202-5258.

Social Worker with taxonomy code 1041C0700X and a focus in Clinical.