Provider Demographics
NPI:1871851840
Name:PENA, JENNIFER NICO (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NICO
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 1:232 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5601
Mailing Address - Country:US
Mailing Address - Phone:646-395-4383
Mailing Address - Fax:212-780-5559
Practice Address - Street 1:232 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5601
Practice Address - Country:US
Practice Address - Phone:646-395-4383
Practice Address - Fax:212-780-5559
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085134-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker