Provider Demographics
NPI:1326713728
Name:ABRAHAM PENA PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:ABRAHAM PENA PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/BODYWORKER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMT
Authorized Official - Phone:206-457-2839
Mailing Address - Street 1:5422 S OTHELLO ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4239
Mailing Address - Country:US
Mailing Address - Phone:206-498-4259
Mailing Address - Fax:
Practice Address - Street 1:5425 RAINIER AVE S STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2455
Practice Address - Country:US
Practice Address - Phone:206-457-2839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty