Individual
DEMELZA MARY PENGELLY
Active
Individual
DEMELZA MARY PENGELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, LCAS-A
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
221410
MA
104100000X
Social Worker
P011117
NC
1041C0700X
Clinical Social Worker
Primary
C012121
NC
Other
Enumeration date
12/15/2016
Last updated
10/01/2019
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