Provider Demographics
NPI:1598817181
Name:PENDERGAST-HERBST, NANCY (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PENDERGAST-HERBST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 KINGSTON RD
Mailing Address - Street 2:STE 319
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3735
Mailing Address - Country:US
Mailing Address - Phone:717-757-1111
Mailing Address - Fax:717-755-2322
Practice Address - Street 1:2550 KINGSTON RD
Practice Address - Street 2:STE 319
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3735
Practice Address - Country:US
Practice Address - Phone:717-757-1111
Practice Address - Fax:717-755-2322
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO0150591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical