MEDICARE: MICAELA PENDOLA MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255296760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAELA PENDOLA MS

Provider Business Mailing Address
First Line	:	1025 WEEPING WILLOW WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-4813
Country	:	US
Telephone Number	:	954-887-8751
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 N OCEAN BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6424
Country	:	US
Telephone Number	:	954-835-5741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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