Healthcare Provider Details

I. General information

NPI: 1235839572
Provider Name (Legal Business Name): JAMES PRENDERGAST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 10/18/2026
Certification Date: 10/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 PLEASANT ST
FALL RIVER MA
02723-1602
US

IV. Provider business mailing address

1052 PLEASANT ST
FALL RIVER MA
02723-1602
US

V. Phone/Fax

Practice location:
  • Phone: 774-322-2101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005755
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16120
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: