# MICHAEL PENDERGAST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043660202
- **Authorized official:** MR. MICHAEL COLE PENDERGAST LICSW (LICENSED INDEPENDENT SOCIAL WORKER)
- **Authorized official phone:** (401) 301-4526

## Contact information

- **Practice address:** 1130 TEN ROD RD, BUILDING D, SUITE 307-C, NORTH KINGSTOWN, RI 02852-4161
- **Practice address phone:** (401) 301-4526
- **Mailing address:** 1130 TEN ROD RD, BUILDING D, SUITE 307-C, NORTH KINGSTOWN, RI 02852-4161
- **Mailing address phone:** (401) 301-4526

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | ISW01338 | RI | Yes |

## Other

- **Enumeration date:** 06/20/2016
- **Last updated:** 06/20/2016