Individual
MICHAEL COLE PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW, ACSW
Contact information
Practice address
4705A OLD POST RD, CHARLESTOWN, RI 02813-1819
(401) 364-7705
Mailing address
PO BOX 899, SOUTH SHORE MENTAL HEALTH CENTER, CHARLESTOWN, RI 02813
(401) 364-7705
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW01338
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27303-7
BLUE CROSS BLUE SHIELD
RI
01
—
408142
BLUE CHIP
RI
05
—
MP34524
—
RI
Enumeration date
12/19/2006
Last updated
08/04/2008
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