Provider Demographics
NPI:1841646395
Name:PENA-OGANDO, JOSEFINA (MSW)
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:PENA-OGANDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JOSEFINA
Other - Middle Name:
Other - Last Name:PENA-OGANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:185 E MAIN ST STE 402
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4432
Mailing Address - Country:US
Mailing Address - Phone:269-925-8222
Mailing Address - Fax:269-925-8354
Practice Address - Street 1:185 E MAIN ST STE 402
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022
Practice Address - Country:US
Practice Address - Phone:269-925-8222
Practice Address - Fax:269-925-8354
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI68010993851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor