Provider Demographics
NPI:1447811690
Name:PENA, KATHLEEN (MSW, CGS, LICSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:MSW, CGS, LICSW
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:GUIDED HEALING
Mailing Address - Street 2:10 DAVOL SQUARE, SUITE 100
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-236-7226
Mailing Address - Fax:401-223-4511
Practice Address - Street 1:GUIDED HEALING C/O THE SEG HUB
Practice Address - Street 2:10 DAVOL SQUARE, SUITE 100
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4752
Practice Address - Country:US
Practice Address - Phone:401-236-7226
Practice Address - Fax:401-223-4511
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW035411041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical