Provider Demographics
NPI:1588122915
Name:PENA, ERICA (MA, LPC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CORK HILL RD
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07439-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5246
Practice Address - Country:US
Practice Address - Phone:973-471-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00643700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional