Provider Demographics
NPI:1780384735
Name:WITHIN THE FRAGMENTS LLC
Entity type:Organization
Organization Name:WITHIN THE FRAGMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCP
Authorized Official - Phone:215-378-7529
Mailing Address - Street 1:117 W PATRICIA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1828
Mailing Address - Country:US
Mailing Address - Phone:215-378-7529
Mailing Address - Fax:
Practice Address - Street 1:117 W PATRICIA RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1828
Practice Address - Country:US
Practice Address - Phone:215-378-7529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty