Provider Demographics
NPI:1790204113
Name:PEMBERTON, ANGELI (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELI
Middle Name:
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PELHAM RD APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-2209
Mailing Address - Country:US
Mailing Address - Phone:914-222-3255
Mailing Address - Fax:
Practice Address - Street 1:92 YONKERS AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3911
Practice Address - Country:US
Practice Address - Phone:914-337-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY009010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health