Individual
MS. ALICIA L PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
567 VAUXHALL ST EXT, SUITE 303, WATERFORD, CT 06386-4341
(860) 447-0888
(860) 447-0832
Mailing address
567 VAUXHALL ST EXT, SUITE 303, WATERFORD, CT 06386-4341
(860) 447-0888
(860) 447-0832
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
004118
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00421183500
—
CT
Enumeration date
10/17/2006
Last updated
07/08/2007
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