Healthcare Provider Details

I. General information

NPI: 1629241716
Provider Name (Legal Business Name): CLARA PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ
PROVIDENCE RI
02906-5139
US

IV. Provider business mailing address

9 AUTUMN ST
PROVIDENCE RI
02905-3005
US

V. Phone/Fax

Practice location:
  • Phone: 401-588-2188
  • Fax:
Mailing address:
  • Phone: 401-521-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW03630
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: