Healthcare Provider Details

I. General information

NPI: 1083173330
Provider Name (Legal Business Name): JUAN B PENA COUNSELING SERVICES LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 07/04/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17501 SW 152ND AVE
MIAMI FL
33187-6311
US

IV. Provider business mailing address

17501 SW 152ND AVE
MIAMI FL
33187-6311
US

V. Phone/Fax

Practice location:
  • Phone: 347-688-3672
  • Fax: 718-228-7361
Mailing address:
  • Phone: 347-688-3672
  • Fax: 718-228-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JUAN B PENA
Title or Position: OWNER
Credential: LCSW
Phone: 347-688-7362