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Individual

MR. MICHAEL ANDREW PENA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMSW

Contact information

Practice address
2325 CERRILLOS RD, SANTA FE, NM 87505-3373
(505) 438-0010
(505) 438-6011
Mailing address
2325 CERRILLOS RD, SANTA FE, NM 87505-3373
(505) 438-0010
(505) 438-6011

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M-07637
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
11479264
NM
05
18677037
NM
Enumeration date
09/15/2008
Last updated
03/02/2015
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