Healthcare Provider Details

I. General information

NPI: 1487661708
Provider Name (Legal Business Name): DEBORAH GENEVIEVE PENDLETON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 N MERIDIAN ST
INDIANAPOLIS IN
46204-1108
US

IV. Provider business mailing address

832 N MERIDIAN ST
INDIANAPOLIS IN
46204-1108
US

V. Phone/Fax

Practice location:
  • Phone: 317-686-5634
  • Fax: 317-287-3739
Mailing address:
  • Phone: 317-287-3729
  • Fax: 317-287-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003758A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: