Provider Demographics
NPI:1376424275
Name:PENA, MILAGROS ISABEL
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:ISABEL
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 1:181 UNION ST STE LL102
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1311
Mailing Address - Country:US
Mailing Address - Phone:781-691-7060
Mailing Address - Fax:781-691-7064
Practice Address - Street 1:181 UNION ST STE LL102
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1311
Practice Address - Country:US
Practice Address - Phone:781-691-7060
Practice Address - Fax:781-691-7064
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator