Provider Demographics
NPI:1336828755
Name:PEMBERTON, BRENDA A
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:PEMBERTON
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 1:5413 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3779
Mailing Address - Country:US
Mailing Address - Phone:215-990-3697
Mailing Address - Fax:
Practice Address - Street 1:461 N 3RD STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4111
Practice Address - Country:US
Practice Address - Phone:215-596-0892
Practice Address - Fax:214-893-5437
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health