Provider Demographics
NPI:1003299462
Name:PENELA, ELIZABETH CARMEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CARMEN
Last Name:PENELA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 PINES BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1212
Mailing Address - Country:US
Mailing Address - Phone:954-577-2727
Mailing Address - Fax:
Practice Address - Street 1:15800 PINES BLVD STE 340
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1212
Practice Address - Country:US
Practice Address - Phone:954-577-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical