Active NPI
Noemi Pena, ACSW
- Mental Health Counselor
- Covina, CA
National Provider Identifier
1689922999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- ASW95119
- Practice address
- 1126 N Grand Ave Ste D
Covina, CA 91724-1552 - Phone
- (626) 967-1667
- NPI assigned
- Aug 16, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 95119 | CA | |
| Case Manager/Care Coordinator | 171M00000X | |||
| Rehabilitation Practitioner | 225400000X | |||
| Mental Health Counselor | 101YM0800X | ASW95119 | CA | Primary |
Addresses
Primary practice location
1126 N Grand Ave Ste D
Covina, CA 91724-1552
Mailing address
550 S Vermont Ave
Los Angeles, CA 90020-1912
Phone (323) 826-6300
Other practice location 1
550 S Vermont Ave
Los Angeles, CA 90020-1912
Phone (323) 826-6300
Other practice location 2
4024 Durfee Ave
El Monte, CA 91732-2510
Phone (323) 221-4134
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| #95-2633765 | Other | CA | MEDI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW95119 | CA | MD | Mental Health Counselor |
| 95119 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642032000000",
"number": "1689922999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 S VERMONT AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201912",
"telephone_number": "323-826-6300",
"fax_number": "323-277-7862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1126 N GRAND AVE STE D",
"city": "COVINA",
"state": "CA",
"postal_code": "917241552",
"telephone_number": "626-967-1667"
}
],
"practiceLocations": [
{
"address_1": "550 S Vermont Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900201912",
"country_code": "US",
"telephone_number": "323-826-6300",
"fax_number": "323-277-7862",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4024 Durfee Ave",
"address_purpose": "LOCATION",
"city": "El Monte",
"state": "CA",
"postal_code": "917322510",
"country_code": "US",
"telephone_number": "323-221-4134",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PENA",
"first_name": "NOEMI",
"name_prefix": "Ms.",
"credential": "ACSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-16",
"last_updated": "2022-01-13",
"certification_date": "2022-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "95119",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "ASW95119",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "#95-2633765",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.