MEDICARE: EDDA PENA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH4002	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750379251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDA PENA LMHC

Provider Business Mailing Address
First Line	:	1065 NE 125TH STREET
Second Line	:	SUITE 409
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5834
Country	:	US
Telephone Number	:	888-852-6672
Fax Number	:	305-503-7363

Provider Business Practice Location Address
First Line	:	11440 N. KENDALL DRIVE
Second Line	:	SUITE 208
City	:	MIAMI
State	:	FL
Zip	:	33176-1024
Country	:	US
Telephone Number	:	888-852-6672
Fax Number	:	305-279-2742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	03/14/2016

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Directions to “ EDDA PENA LMHC” Practice Location

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