Provider Demographics
NPI:1942683529
Name:PENDERGAST, JAMES III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:PENDERGAST
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MOSS ST
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-2113
Mailing Address - Country:US
Mailing Address - Phone:207-749-6101
Mailing Address - Fax:
Practice Address - Street 1:50 MOSS ST
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-2113
Practice Address - Country:US
Practice Address - Phone:207-749-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical