Provider Demographics
NPI:1033927488
Name:PAGAN PENA, JULISSA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULISSA
Middle Name:M
Last Name:PAGAN PENA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CALLE JESUS M MUNOZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2237
Mailing Address - Country:US
Mailing Address - Phone:787-398-5520
Mailing Address - Fax:
Practice Address - Street 1:4732 N AUSTIN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3785
Practice Address - Country:US
Practice Address - Phone:214-301-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty