Individual
ROSE MARIE PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
580 ELLIS RD S, SUITE 118, JACKSONVILLE, FL 32254-3582
(904) 423-0017
(904) 683-8169
Mailing address
580 ELLIS RD S, SUITE 118, JACKSONVILLE, FL 32254-3582
(904) 423-0017
(904) 683-8169
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMT2414
FL
Other
Enumeration date
12/02/2015
Last updated
12/02/2015
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