MEDICARE: CARMEN PENDLETON LCPC

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	101YP2500X	Professional Counselor	LC11804	MD

General Provider Information

NPI Number	:	1194374835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN PENDLETON LCPC

Provider Business Mailing Address
First Line	:	1599 INGLESIDE AVE
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-4956
Country	:	US
Telephone Number	:	484-744-0274
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 INGLESIDE AVE
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-4945
Country	:	US
Telephone Number	:	484-744-0274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	04/09/2026

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