Provider Demographics
NPI:1336892561
Name:PENDER, KASMYNE (LMSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KASMYNE
Middle Name:
Last Name:PENDER
Suffix:
Gender:M
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 THAYER DR APT 602
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-7007
Mailing Address - Country:US
Mailing Address - Phone:404-403-0874
Mailing Address - Fax:
Practice Address - Street 1:688 6TH STREET
Practice Address - Street 2:
Practice Address - City:FORT RICHARDSON
Practice Address - State:AA
Practice Address - Zip Code:99505
Practice Address - Country:US
Practice Address - Phone:907-384-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903002915104100000X
NCP0153431041S0200X
NCC0157411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool