Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 1041C0700X | Clinical Social Worker | LCSW68088 | CA |
NPI | 1003123258 |
---|---|
Provider Name | Miss Veronica Pena Barajas |
First Address | Belmont, CA 94002 |
Second Address | San Mateo, CA 94402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2010 |
Last Update Date | 29/01/2020 |