Provider Demographics
NPI:1114170800
Name:PENA, MEGAN SHAE-ROBINSON (MA)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:SHAE-ROBINSON
Last Name:PENA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 ORCHARD VISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7069
Mailing Address - Country:US
Mailing Address - Phone:616-240-4950
Mailing Address - Fax:
Practice Address - Street 1:3075 ORCHARD VISTA DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7069
Practice Address - Country:US
Practice Address - Phone:616-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006314103T00000X
MI6301013842103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist