MEDICARE: MR. HERIBERTO PENA JR. LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	58767	TX

General Provider Information

NPI Number	:	1144109109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HERIBERTO PENA JR. LCSW

Provider Business Mailing Address
First Line	:	12370 POTRANCO RD
Second Line	:	SUITE 207 PMB 1239
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4260
Country	:	US
Telephone Number	:	956-337-2076
Fax Number	:

Provider Business Practice Location Address
First Line	:	12370 POTRANCO RD
Second Line	:	SUITE 207 PMB 1239
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4260
Country	:	US
Telephone Number	:	956-337-2076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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