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NPI Code Detail

MEDICARE: JAMIE DAURELL PEMBERTON LMSW

MEDICARE: JAMIE DAURELL PEMBERTON LMSW
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
1104100000XSocial Worker125733NY

General Provider Information

NPI Number : 1346107547
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE DAURELL PEMBERTON LMSW
Provider Business Mailing Address
First Line : 226 KIMBERLY PL APT 3C
Second Line :
City : BRONX
State : NY
Zip : 10463-5307
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4401 BRONX BLVD
Second Line :
City : BRONX
State : NY
Zip : 10470-1407
Country : US
Telephone Number : 718-304-7169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2026
Last Update Date : 01/08/2026

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Directions to “ JAMIE DAURELL PEMBERTON LMSW” Practice Location

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