Provider Demographics
NPI:1669506093
Name:PENA, MARIA CARMEN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:CARMEN
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 1:0-86 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2911
Mailing Address - Country:US
Mailing Address - Phone:120-279-7506
Mailing Address - Fax:
Practice Address - Street 1:1770 STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6409
Practice Address - Country:US
Practice Address - Phone:171-865-2979
Practice Address - Fax:171-854-7910
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501471041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool