Healthcare Provider Details

I. General information

NPI: 1639710676
Provider Name (Legal Business Name): HILARY PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 EASTERN AVE STE 8
DEDHAM MA
02026-4582
US

IV. Provider business mailing address

95 EASTERN AVE STE 8
DEDHAM MA
02026-4582
US

V. Phone/Fax

Practice location:
  • Phone: 617-996-1210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10002304
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: