Provider Demographics
NPI:1831967272
Name:PENA, WALESKA ANGELICA
Entity type:Individual
Prefix:MS
First Name:WALESKA
Middle Name:ANGELICA
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 MERRIMACK ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1707
Mailing Address - Country:US
Mailing Address - Phone:978-455-0756
Mailing Address - Fax:978-455-0770
Practice Address - Street 1:100 MERRIMACK ST STE 205
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1707
Practice Address - Country:US
Practice Address - Phone:978-455-0756
Practice Address - Fax:978-455-0770
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health