Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003273368 |
---|---|
Provider Name | Angelin Isabel Pena |
First Address | Lawrence, MA 01840-1244 |
Second Address | Lawrence, MA 01840-1244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2016 |
Last Update Date | 18/01/2016 |