Provider Demographics
NPI:1104527431
Name:PENDRY, DAVID (MSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PENDRY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20522 MARLIN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-3976
Mailing Address - Country:US
Mailing Address - Phone:407-965-9428
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND ST BLDG 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-646-5500
Practice Address - Fax:407-623-8640
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW18059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker