Healthcare Provider Details

I. General information

NPI: 1841646395
Provider Name (Legal Business Name): JOSEFINA PENA-OGANDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSEFINA PENA-OGANDO LCSW

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6572 RED ARROW HWY STE 2
COLOMA MI
49038-8700
US

IV. Provider business mailing address

PO BOX 549
COLOMA MI
49038-0549
US

V. Phone/Fax

Practice location:
  • Phone: 269-235-5237
  • Fax:
Mailing address:
  • Phone: 269-235-5237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118703
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: