Doctor Name: | MARIAN ROSE PENA |
NPI Number: | 1053441519 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LCS16704 |
Business Practice Address: | 15230 Lakeshore Dr Clearlake, CA - 954228107 |
Business Phone Number: | 7079954500 |
Business Fax Number: | 7079952401 |
Mailing Address: | 11049 Wheeler Dr, KELSEYVILLE |
State: | CA |
Postal Code: | 954519752 |
Phone Number: | 7072770346 |
Fax Number: | |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCS16704 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |