Provider Demographics
NPI:1619116688
Name:PENA, LORNA M (MA)
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:M
Last Name:PENA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190044
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0044
Mailing Address - Country:US
Mailing Address - Phone:787-638-2656
Mailing Address - Fax:
Practice Address - Street 1:AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1808
Practice Address - Country:US
Practice Address - Phone:787-638-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3279103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist