Provider Demographics
NPI:1881960656
Name:PENDERGAST, MARLENE V
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:V
Last Name:PENDERGAST
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 1:46 E 1ST ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9309
Mailing Address - Country:US
Mailing Address - Phone:305-321-0616
Mailing Address - Fax:
Practice Address - Street 1:46 E 1ST ST
Practice Address - Street 2:APT 4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9309
Practice Address - Country:US
Practice Address - Phone:305-321-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool