Provider Demographics
NPI:1730935982
Name:PENA, YAJAIRA R
Entity type:Individual
Prefix:
First Name:YAJAIRA
Middle Name:R
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 1:14045 ASH AVE APT 526
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2750
Mailing Address - Country:US
Mailing Address - Phone:646-945-7845
Mailing Address - Fax:
Practice Address - Street 1:14045 ASH AVE APT 526
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2750
Practice Address - Country:US
Practice Address - Phone:646-945-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker