Provider Demographics
NPI:1871760124
Name:PENA, KAREN M (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:PENA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2550 INDEPENDENCE AVE
Mailing Address - Street 2:APT 7F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6225
Mailing Address - Country:US
Mailing Address - Phone:917-658-2375
Mailing Address - Fax:212-305-9099
Practice Address - Street 1:140 W 97TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6450
Practice Address - Country:US
Practice Address - Phone:917-658-2375
Practice Address - Fax:212-305-7400
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070189-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical