Individual provider Active NPI

Mary Kathryn Pendley, LCSW

  • Clinical Social Worker
  • Ashland, KY
National Provider Identifier
1619909124
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
KY1931 Issued in KY
Practice address
3701 Lansdowne Dr
Ashland, KY 41102
Phone
(606) 324-3005
Fax
(606) 329-1530
NPI assigned
Jul 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X KY1931 KY Primary

Addresses

Primary practice location

3701 Lansdowne Dr
Ashland, KY 41102

Mailing address

PO Box 790
Ashland, KY 41105-0790
Phone (606) 329-8588

Other identifiers 3

IdentifierTypeStateIssuer
1223428OtherCHA
30610026MedicaidKY
000000372231OtherANTHEM BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
KY1931KYMDClinical Social Worker
1931KYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619909124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411050790",
            "telephone_number": "606-329-8588",
            "fax_number": "606-329-8195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 LANSDOWNE DR",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "41102",
            "telephone_number": "606-324-3005",
            "fax_number": "606-329-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDLEY",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "KY1931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA",
            "identifier": "1223428",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30610026",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000372231",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, KY

Sources for this page

  • 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.