Healthcare Provider Details

I. General information

NPI: 1841463718
Provider Name (Legal Business Name): PATRICIA PENA PPSC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 MCDOUGALL ST
CASTROVILLE CA
95012-2523
US

IV. Provider business mailing address

10821 AXTELL ST
CASTROVILLE CA
95012-2867
US

V. Phone/Fax

Practice location:
  • Phone: 831-633-5975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number170033902
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: