Provider Demographics
NPI:1861797110
Name:PENA, LINDA ELAINE (MA, CADC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELAINE
Last Name:PENA
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 E LIVINGSTON DR APT 9
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2766
Mailing Address - Country:US
Mailing Address - Phone:562-833-5554
Mailing Address - Fax:
Practice Address - Street 1:812 W TOWN AND COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4712
Practice Address - Country:US
Practice Address - Phone:714-547-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist