=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770887838
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY ANN PENA LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2011
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18166 PARROT RD
-----------------------------------------------------
City | WEEKI WACHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34614-0318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-378-2287
-----------------------------------------------------
Fax | 727-645-4798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18166 PARROT RD
-----------------------------------------------------
City | WEEKI WACHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34614-0318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-917-1379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 253113
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 65706
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW16966
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------