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General NPI Number Information
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NPI Number | 1093208142
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Entity Type | Individual
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Provider Name | ADRIANNA MARISOL PENA-VAN DEN BOSSCHE LLC, BCABA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 34441 8 MILE RD STE AND116
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City | LIVONIA
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State | MI
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Zip | 48152-4013
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Country | US
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Telephone | 734-469-0513
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Fax |
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Provider Business Mailing Address
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Address Line | 7108 S KANNER HWY
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City | STUART
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State | FL
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Zip | 34997-7462
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Country | US
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Telephone | 855-832-6727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-21-12659
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451023863
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License Number State | MI
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