Provider Demographics
NPI:1528266947
Name:PENDER, COURTNEY LEE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:PENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 LOYOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2644
Mailing Address - Country:US
Mailing Address - Phone:310-844-4969
Mailing Address - Fax:
Practice Address - Street 1:439 W. 97TH ST.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003
Practice Address - Country:US
Practice Address - Phone:323-754-2856
Practice Address - Fax:323-754-1843
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical