Provider Demographics
NPI:1376783761
Name:PENA, MARIBEL (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 TOWNSEND AVE
Mailing Address - Street 2:APT. 1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7973
Mailing Address - Country:US
Mailing Address - Phone:718-731-2492
Mailing Address - Fax:
Practice Address - Street 1:796H DREW ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4704
Practice Address - Country:US
Practice Address - Phone:718-235-3100
Practice Address - Fax:718-277-0822
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078695104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker