Provider Demographics
NPI:1730111816
Name:PENA-OFFERDAHL, NUBIA ANGELA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NUBIA
Middle Name:ANGELA
Last Name:PENA-OFFERDAHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2650 JAMACHA RD
Mailing Address - Street 2:#147 PMB 55
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4319
Mailing Address - Country:US
Mailing Address - Phone:619-818-4351
Mailing Address - Fax:619-303-7093
Practice Address - Street 1:815 3RD AVE
Practice Address - Street 2:#317
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1307
Practice Address - Country:US
Practice Address - Phone:619-818-4351
Practice Address - Fax:619-303-7093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20829101YM0800X
TX41563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health