Provider Demographics
NPI:1447573951
Name:PENA, DYNIKER
Entity type:Individual
Prefix:MRS
First Name:DYNIKER
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DIMOCK ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1210
Mailing Address - Country:US
Mailing Address - Phone:617-989-2860
Mailing Address - Fax:617-445-9147
Practice Address - Street 1:30 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1210
Practice Address - Country:US
Practice Address - Phone:617-989-2860
Practice Address - Fax:617-445-9147
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor