Healthcare Provider Details

I. General information

NPI: 1114282365
Provider Name (Legal Business Name): GAIL N. PENDLETON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 59 SUITE L-1
AIRMONT NY
10901-4927
US

IV. Provider business mailing address

23 GLADYS DR
SPRING VALLEY NY
10977-6026
US

V. Phone/Fax

Practice location:
  • Phone: 845-369-9701
  • Fax: 845-369-9704
Mailing address:
  • Phone: 845-425-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: