Provider Demographics
NPI:1588554992
Name:DE LA PENA, DEANDRA SOPHIA
Entity type:Individual
Prefix:
First Name:DEANDRA
Middle Name:SOPHIA
Last Name:DE LA 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 1:1208 W LILLY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5024
Mailing Address - Country:US
Mailing Address - Phone:682-558-9789
Mailing Address - Fax:
Practice Address - Street 1:9201 N CENTRAL EXPY STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6033
Practice Address - Country:US
Practice Address - Phone:214-851-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-308505106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician