Provider Demographics
NPI:1366997595
Name:PENA, CARELYS (MA)
Entity type:Individual
Prefix:MS
First Name:CARELYS
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 107 KM 1.1
Mailing Address - Street 2:LOCAL B
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9999
Mailing Address - Country:US
Mailing Address - Phone:787-673-0599
Mailing Address - Fax:
Practice Address - Street 1:109 LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-1327
Practice Address - Country:US
Practice Address - Phone:787-673-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5703103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling