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General NPI Number Information
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NPI Number | 1598288037
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Entity Type | Individual
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Provider Name | DENISE MARIE PRENDERGAST LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 2691 MITSCHER RD SW BLDG 414
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City | WASHINGTON
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State | DC
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Zip | 20373-5108
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Country | US
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Telephone | 202-685-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 3313 COMMONWEALTH AVE APT C
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City | ALEXANDRIA
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State | VA
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Zip | 22305-2834
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Country | US
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Telephone | 434-470-0459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007886
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License Number State | VA
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