Healthcare Provider Details

I. General information

NPI: 1558759951
Provider Name (Legal Business Name): SENECA PENDER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E BOLTON ST
SAVANNAH GA
31401-5920
US

IV. Provider business mailing address

408 E BOLTON ST
SAVANNAH GA
31401-5920
US

V. Phone/Fax

Practice location:
  • Phone: 912-447-5530
  • Fax:
Mailing address:
  • Phone: 443-480-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01758
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: