Provider Demographics
NPI:1326119546
Name:DE PENA, SHIRLEY SHARON (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:SHARON
Last Name:DE PENA
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 1:535 EDGECOMBE AVE
Mailing Address - Street 2:APT# 23
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 EINSTEIN LOOP
Practice Address - Street 2:ROOM 46
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4974
Practice Address - Country:US
Practice Address - Phone:718-320-3082
Practice Address - Fax:718-379-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0719441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical