MEDICARE: JOSEPH RODRIGUEZ PENA LLPC

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	101Y00000X	Counselor	L1243789	MI

General Provider Information

NPI Number	:	1982881660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH RODRIGUEZ PENA LLPC

Provider Business Mailing Address
First Line	:	3916 ACADEMY ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2202
Country	:	US
Telephone Number	:	313-274-0913
Fax Number	:

Provider Business Practice Location Address
First Line	:	3916 ACADEMY ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2202
Country	:	US
Telephone Number	:	313-274-0913
Fax Number	:

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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