Provider Demographics
NPI:1205219292
Name:PENDLETON, ROSE (MA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-4019
Mailing Address - Country:US
Mailing Address - Phone:650-787-1006
Mailing Address - Fax:
Practice Address - Street 1:131 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-4019
Practice Address - Country:US
Practice Address - Phone:650-787-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool