Provider Demographics
NPI:1396409074
Name:PENA, JANINNA (LCSW)
Entity Type:Individual
Prefix:
First Name:JANINNA
Middle Name:
Last Name: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 1:128 N FM 3167
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6211
Mailing Address - Country:US
Mailing Address - Phone:956-370-6029
Mailing Address - Fax:956-370-6560
Practice Address - Street 1:496 ACASIA ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6260
Practice Address - Country:US
Practice Address - Phone:956-435-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX636551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical