Provider Demographics
NPI:1184199382
Name:PEMBERTON, ROSENNA DAVITA HINNANT (LPC)
Entity Type:Individual
Prefix:
First Name:ROSENNA
Middle Name:DAVITA HINNANT
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W 13TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1343
Mailing Address - Country:US
Mailing Address - Phone:201-304-7957
Mailing Address - Fax:201-510-0758
Practice Address - Street 1:95 W 13TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1343
Practice Address - Country:US
Practice Address - Phone:201-668-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00630300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional