Provider Demographics
NPI:1053022590
Name:PENDERGAST, JESSICA ELAINE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELAINE
Last Name:PENDERGAST
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W PATRICIA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1828
Mailing Address - Country:US
Mailing Address - Phone:215-378-7529
Mailing Address - Fax:
Practice Address - Street 1:865 EASTON RD STE 180
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1879
Practice Address - Country:US
Practice Address - Phone:215-999-4724
Practice Address - Fax:267-762-4368
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional