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General NPI Number Information
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NPI Number | 1316043722
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Entity Type | Individual
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Provider Name | ROBERTO PENA JR. LCSW, CADC
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 01/30/2016
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Provider Practice Location Address
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Address Line | 2244 W 95TH STREET
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City | NAPERVILLE
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State | IL
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Zip | 60564-8033
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Country | US
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Telephone | 630-756-5640
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Fax | 630-378-9830
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Provider Business Mailing Address
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Address Line | PO BOX 9657
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City | NAPERVILLE
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State | IL
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Zip | 60567-0657
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Country | US
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Telephone | 630-378-9830
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.016610
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License Number State | IL
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