Provider Demographics
NPI:1245485515
Name:PENDERGRASS, ASHLEY RENEE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:RENEE
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:118 THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8087
Mailing Address - Country:US
Mailing Address - Phone:561-876-6118
Mailing Address - Fax:
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-628-3963
Practice Address - Fax:561-422-1325
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical