Healthcare Provider Details

I. General information

NPI: 1447925672
Provider Name (Legal Business Name): NICHOLAS PENNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 RODMAN RD
AUBURN ME
04210-3942
US

IV. Provider business mailing address

800 CENTER ST
AUBURN ME
04210-6404
US

V. Phone/Fax

Practice location:
  • Phone: 207-376-3022
  • Fax:
Mailing address:
  • Phone: 207-782-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLC23810
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: