Provider Demographics
NPI:1346378858
Name:PRENDERGAST, ELAINE M (LCSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:M
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18C S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2203
Mailing Address - Country:US
Mailing Address - Phone:856-662-1660
Mailing Address - Fax:856-662-6110
Practice Address - Street 1:18C S CENTRE ST
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2203
Practice Address - Country:US
Practice Address - Phone:856-662-1660
Practice Address - Fax:856-662-6110
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001357001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical