Provider Demographics
NPI:1487985180
Name:PENA, PATRICIA RUTH
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RUTH
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 AMORY ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4502
Mailing Address - Country:US
Mailing Address - Phone:617-390-5873
Mailing Address - Fax:
Practice Address - Street 1:171 AMORY ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4502
Practice Address - Country:US
Practice Address - Phone:617-390-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral