Provider Demographics
NPI:1053507616
Name:PENA, ANGELA EVA (LMSW, CBIS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:EVA
Last Name:PENA
Suffix:
Gender:F
Credentials:LMSW, CBIS
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:EVA
Other - Last Name:SPAGNUOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1806 LINDY DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-9734
Mailing Address - Country:US
Mailing Address - Phone:517-940-0905
Mailing Address - Fax:
Practice Address - Street 1:1806 LINDY DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-9734
Practice Address - Country:US
Practice Address - Phone:517-940-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical