Provider Demographics
NPI:1013038652
Name:PETTENGILL, MICHELLE ALBANESE (ASW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALBANESE
Last Name:PETTENGILL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4333
Mailing Address - Country:US
Mailing Address - Phone:408-243-0222
Mailing Address - Fax:
Practice Address - Street 1:3490 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4333
Practice Address - Country:US
Practice Address - Phone:408-243-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health