Provider Demographics
NPI:1538114467
Name:PENDERY, NANCY (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:PENDERY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 PEGGY LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2330
Mailing Address - Country:US
Mailing Address - Phone:301-585-3641
Mailing Address - Fax:301-495-0298
Practice Address - Street 1:2313 PEGGY LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2330
Practice Address - Country:US
Practice Address - Phone:301-585-3641
Practice Address - Fax:301-495-0298
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD083501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100033559001OtherAPS HEALTHCARE
MD140301000Medicaid
DC5662 0001OtherBLUE CROSS SHIELD