Provider Demographics
NPI:1831472018
Name:PENDLETON, DEREK (LCSW, ACSW, BCD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:M
Credentials:LCSW, ACSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 OLD YORK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2013
Mailing Address - Country:US
Mailing Address - Phone:215-444-9204
Mailing Address - Fax:215-444-9206
Practice Address - Street 1:1210 OLD YORK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2013
Practice Address - Country:US
Practice Address - Phone:215-444-9204
Practice Address - Fax:215-444-9206
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0179771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical