Provider Demographics
NPI:1194105569
Name:PENA, YIBELIS TATIANA
Entity type:Individual
Prefix:
First Name:YIBELIS
Middle Name:TATIANA
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HANSON ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1345
Mailing Address - Country:US
Mailing Address - Phone:978-210-1142
Mailing Address - Fax:
Practice Address - Street 1:32 HANSON ST
Practice Address - Street 2:APT 2
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1345
Practice Address - Country:US
Practice Address - Phone:978-210-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor