Provider Demographics
NPI:1992466718
Name:PENDERGRASS, MARGARET ROSSI (LCSW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSSI
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 RAMSDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3339
Mailing Address - Country:US
Mailing Address - Phone:314-307-1428
Mailing Address - Fax:
Practice Address - Street 1:114 SLOAN ST STE 201
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4922
Practice Address - Country:US
Practice Address - Phone:678-250-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0077741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical