Provider Demographics
NPI:1811953482
Name:PENDLEBURY, SHARON A (LCSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:PENDLEBURY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 W 10TH ST STE 200
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4468
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:888-965-4615
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000004771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q63024Medicare UPIN
804543Medicare ID - Type Unspecified