Provider Demographics
NPI:1083591820
Name:PENA, ROSEMARY (LSW)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 VALLEY BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1926
Mailing Address - Country:US
Mailing Address - Phone:201-220-6943
Mailing Address - Fax:
Practice Address - Street 1:460 BLOOMFIELD AVE STE 209
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3552
Practice Address - Country:US
Practice Address - Phone:201-429-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070156001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical