Provider Demographics
NPI:1679229041
Name:PENA, SANDRA (LMSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:PICHARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2980 S RAINBOW BLVD # 210D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6531
Mailing Address - Country:US
Mailing Address - Phone:562-713-0486
Mailing Address - Fax:
Practice Address - Street 1:2980 S RAINBOW BLVD # 210D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-673-7462
Practice Address - Fax:702-442-8900
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9682-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical