Provider Demographics
NPI:1083878805
Name:PEMBERTON, JOLENE N (LMSW)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:N
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 FORT ST RM 505
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3936
Mailing Address - Country:US
Mailing Address - Phone:810-966-0099
Mailing Address - Fax:810-696-7339
Practice Address - Street 1:511 FORT ST RM 505
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3936
Practice Address - Country:US
Practice Address - Phone:810-966-0099
Practice Address - Fax:810-696-7339
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker