Provider Demographics
NPI:1508682717
Name:PENA, MELISA MARLENI (LICSW)
Entity type:Individual
Prefix:MS
First Name:MELISA
Middle Name:MARLENI
Last Name:PENA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7043
Mailing Address - Country:US
Mailing Address - Phone:202-487-5389
Mailing Address - Fax:
Practice Address - Street 1:1101 CONNECTICUT AVE NW STE 450
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4359
Practice Address - Country:US
Practice Address - Phone:202-706-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000037161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical