Provider Demographics
NPI:1770887838
Name:PENA, NANCY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:PENA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18166 PARROT RD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-0318
Mailing Address - Country:US
Mailing Address - Phone:580-917-1379
Mailing Address - Fax:
Practice Address - Street 1:18166 PARROT RD
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-0318
Practice Address - Country:US
Practice Address - Phone:727-378-2287
Practice Address - Fax:727-645-4798
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
KY2531131041C0700X
TX657061041C0700X
FLSW169661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV225400000XMedicaid
TX65706OtherLICENSE