MEDICARE: MADELYN PEMBERTON

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	106H00000X	Marriage & Family Therapist		NC

General Provider Information

NPI Number	:	1407715188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN PEMBERTON

Provider Business Mailing Address
First Line	:	3844 BATTLEGROUND AVE APT 14
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3844 BATTLEGROUND AVE APT 14
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9432
Country	:	US
Telephone Number	:	832-206-8770
Fax Number	:

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ MADELYN PEMBERTON ” Practice Location

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