MEDICARE: PEMBROKE PSYCHOLOGICAL SERVICES LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	2675	NC
2	103TC1900X	Counseling Psychologist	1427	NC
3	1041C0700X	Clinical Social Worker	C000391	NC
4	106H00000X	Marriage & Family Therapist	008	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02657	OTHER	NC	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1184666893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEMBROKE PSYCHOLOGICAL SERVICES LLP

Provider Business Mailing Address
First Line	:	6512 SIX FORKS RD
Second Line	:	STE 202A
City	:	RALEIGH
State	:	NC
Zip	:	27615-6561
Country	:	US
Telephone Number	:	919-846-9142
Fax Number	:	919-846-9451

Provider Business Practice Location Address
First Line	:	6512 SIX FORKS RD
Second Line	:	STE 202A
City	:	RALEIGH
State	:	NC
Zip	:	27615-6561
Country	:	US
Telephone Number	:	919-846-9142
Fax Number	:	919-846-9451

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ARMAND E OCCHETTI
Credential	:	LCSW
Telephone Number	:	919-846-9142

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	09/11/2025

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