Michael Pendergast

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01338 Issued in RI

Legal business name

MICHAEL PENDERGAST

Practice address

1130 Ten Rod Rd
Building D, Suite 307-C
North Kingstown, RI 02852-4161

Phone

(401) 301-4526

NPI assigned

Jun 20, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Cole Pendergast, LICSWNPI 1124181243

Title

Licensed Independent Social Worker

Phone

(401) 301-4526

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Cole Pendergast, MSW, LICSW, ACSW

  • Clinical Social Worker
  • Charlestown, RI
  • NPI 1124181243
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466380800000",
    "number": "1043660202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 TEN ROD RD",
            "address_2": "BUILDING D, SUITE 307-C",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028524161",
            "telephone_number": "401-301-4526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 TEN ROD RD",
            "address_2": "BUILDING D, SUITE 307-C",
            "city": "NORTH KINGSTOWN",
            "state": "RI",
            "postal_code": "028524161",
            "telephone_number": "401-301-4526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL PENDERGAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-06-20",
        "status": "A",
        "authorized_official_last_name": "PENDERGAST",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "COLE",
        "authorized_official_title_or_position": "LICENSED INDEPENDENT SOCIAL WORKER",
        "authorized_official_telephone_number": "401-301-4526",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1124181243",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory M McWilliams, BS, LCDP
• Jessica Meade, DC
• Medical Equipment Recyclers of New England
• Zoila Medina
• Edward G Merchant, DPT
• Jennifer Michaud, PTA
• Kimberly Micucci, LCDP
• Lynn Vere Miller, O.D.
• Mary Jane Milner, R.N., C.D.E., C.D.O.
• Maureen Laferty Minarik, PH.D.

• Clinical Social Worker in North Kingstown, RI
• Providers in North Kingstown, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.