Healthcare Provider Details

I. General information

NPI: 1053507616
Provider Name (Legal Business Name): ANGELA EVA PENA LMSW, CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA EVA SPAGNUOLO LMSW

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 10/25/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 LINDY DR
LANSING MI
48917-9734
US

IV. Provider business mailing address

1806 LINDY DR
LANSING MI
48917-9734
US

V. Phone/Fax

Practice location:
  • Phone: 517-940-0905
  • Fax:
Mailing address:
  • Phone: 517-940-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089519
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: