Mary Norcott Pemberton, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

002301 Issued in CT

Practice address

60 Boston Post Road
Madison, CT 06443

Phone

(203) 245-2029

NPI assigned

Oct 26, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sunshine Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Madison, CT
  • NPI 1619779907
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609951698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MONTICELLO DRIVE",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "06405",
            "telephone_number": "203-488-3340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 BOSTON POST ROAD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "06443",
            "telephone_number": "203-245-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEMBERTON",
        "first_name": "MARY",
        "middle_name": "NORCOTT",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "002301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "193075",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "140002301CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "076199",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul J. Coppola, MD, PC
• Bennett Allen Paul, DDS
• Jessica L Paulson, PA-C
• Peak Nutrition
• Pediatric Dentistry Associates, LLC
• Amanda Rose Perez, DNP, FNP-C
• Rebecca Lee Petersen
• W. Dean Pfeifer, PHD
• Physical Therapy and Wellness Treatment Center, LLC
• Physical Therapy Center of Madison (Therapeutic Centre)

• Clinical Social Worker in Madison, CT
• Providers in Madison, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.