Healthcare Provider Details

I. General information

NPI: 1366175762
Provider Name (Legal Business Name): MARTHA ANN PENDER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 LAKEWOOD RD STE 102
TOMS RIVER NJ
08753-2237
US

IV. Provider business mailing address

1198 LAKEWOOD RD STE 102
TOMS RIVER NJ
08753-2237
US

V. Phone/Fax

Practice location:
  • Phone: 352-745-1320
  • Fax:
Mailing address:
  • Phone: 732-736-6559
  • Fax: 732-797-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06675300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: