Provider Demographics
NPI:1134389836
Name:PRENDERGAST, KATE MARGARET
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:MARGARET
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVER ST
Mailing Address - Street 2:THUNDERMIST HEALTH CENTER
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3214
Mailing Address - Country:US
Mailing Address - Phone:401-783-0523
Mailing Address - Fax:401-783-9448
Practice Address - Street 1:1 RIVER ST
Practice Address - Street 2:THUNDERMIST HEALTH CENTER
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3214
Practice Address - Country:US
Practice Address - Phone:401-783-0523
Practice Address - Fax:401-783-9448
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICERTIFICATE #447101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor