Healthcare Provider Details

I. General information

NPI: 1992084321
Provider Name (Legal Business Name): KASEY ROSE PENDEXTER LMFT, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 CENTRAL ST
FRAMINGHAM MA
01701-4815
US

IV. Provider business mailing address

150 LOWER GORE RD
WEBSTER MA
01570-3414
US

V. Phone/Fax

Practice location:
  • Phone: 508-626-8581
  • Fax:
Mailing address:
  • Phone: 774-432-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1503
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: