Provider Demographics
NPI:1316043722
Name:PENA, ROBERTO JR (LCSW, CADC)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:PENA
Suffix:JR
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9657
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-0657
Mailing Address - Country:US
Mailing Address - Phone:630-378-9830
Mailing Address - Fax:
Practice Address - Street 1:2244 W 95TH STREET
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8033
Practice Address - Country:US
Practice Address - Phone:630-756-5640
Practice Address - Fax:630-378-9830
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0166101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical