Provider Demographics
NPI:1700070802
Name:PENA, EDGAR ALFONSO (LMHC, CAP)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:ALFONSO
Last Name:PENA
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 NE 123 ST #1212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161
Mailing Address - Country:US
Mailing Address - Phone:786-223-3334
Mailing Address - Fax:305-766-8064
Practice Address - Street 1:1354 WASHINGTON AVE STE 221
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4203
Practice Address - Country:US
Practice Address - Phone:786-223-3334
Practice Address - Fax:305-766-8064
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 5058101YA0400X
FLMH 10529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)