Provider Demographics
NPI:1407163603
Name:PENA, RAQUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-2823
Mailing Address - Country:US
Mailing Address - Phone:215-426-9680
Mailing Address - Fax:215-426-9683
Practice Address - Street 1:3169 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-2823
Practice Address - Country:US
Practice Address - Phone:215-426-9680
Practice Address - Fax:215-426-9683
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health