Provider Demographics
NPI:1326836602
Name:BOROS, PENINA
Entity type:Individual
Prefix:
First Name:PENINA
Middle Name:
Last Name:BOROS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 CHALET GARDENS RD APT 4
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6027
Mailing Address - Country:US
Mailing Address - Phone:763-248-4755
Mailing Address - Fax:
Practice Address - Street 1:8500 GREENWAY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4713
Practice Address - Country:US
Practice Address - Phone:608-516-1734
Practice Address - Fax:608-535-6874
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health