Kenny Jandiel Pena | Roxbury, MA • PECOS Search

Kenny Jandiel Pena

Counselor

Behavioral Health & Social Service Providers

504 Dudley St, Roxbury, MA 02119-2732

(617) 445-6655 (857) 214-9635

PECOS Enrollment

Based on the most recent information from CMS, provider Kenny Jandiel Pena does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1891563110
Provider Type
Individual
Full Name
Pena, Kenny Jandiel
Gender
Male

Sole Proprietor
No
Enumeration Date
12/15/2023
Last Updated
12/27/2023

Contact Information

Practice Location

504 Dudley St, Roxbury, MA 02119-2732

Unlisted Fax

Mailing Location

824 Jette Ct, Brighton, MA 02135-4439

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101Y00000X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer