Healthcare Provider Details

I. General information

NPI: 1245619402
Provider Name (Legal Business Name): ABRAHAM J PENA LMP, MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 S HUDSON ST STE 102
SEATTLE WA
98118-2171
US

IV. Provider business mailing address

3715 S HUDSON ST STE 102
SEATTLE WA
98118-2171
US

V. Phone/Fax

Practice location:
  • Phone: 206-457-2839
  • Fax:
Mailing address:
  • Phone: 206-745-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60814904
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60529305
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: