Provider Demographics
NPI:1437588837
Name:PENA, ARIAM IVETTE (MA)
Entity type:Individual
Prefix:
First Name:ARIAM
Middle Name:IVETTE
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 1:43005 ATOKA MANOR TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7546
Mailing Address - Country:US
Mailing Address - Phone:470-351-8219
Mailing Address - Fax:
Practice Address - Street 1:11260 ROGER BACON DR STE 103
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5203
Practice Address - Country:US
Practice Address - Phone:703-782-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013442101YP2500X
GALPC013366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295Medicaid