Provider Demographics
NPI:1659176600
Name:PENA MONDRAGON, JANETHE
Entity type:Individual
Prefix:
First Name:JANETHE
Middle Name:
Last Name:PENA MONDRAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANETHE
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3060 16TH ST NW APT 310
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4238
Mailing Address - Country:US
Mailing Address - Phone:202-352-7073
Mailing Address - Fax:
Practice Address - Street 1:3060 16TH ST NW APT 310
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4238
Practice Address - Country:US
Practice Address - Phone:202-352-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health