MEDICARE: ANGELICA PENA FERNANDEZ LPCC

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	101YM0800X	Mental Health Counselor	165571	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962872606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA PENA FERNANDEZ LPCC

Provider Business Mailing Address
First Line	:	5301 THOMAS DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1953
Country	:	US
Telephone Number	:	505-226-0602
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 THOMAS DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1953
Country	:	US
Telephone Number	:	505-226-0602
Fax Number	:

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

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	06/03/2026

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