Provider Demographics
NPI:1184666893
Name:PEMBROKE PSYCHOLOGICAL SERVICES LLP
Entity type:Organization
Organization Name:PEMBROKE PSYCHOLOGICAL SERVICES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMAND
Authorized Official - Middle Name:E
Authorized Official - Last Name:OCCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-846-9142
Mailing Address - Street 1:6512 SIX FORKS RD
Mailing Address - Street 2:STE 202A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6561
Mailing Address - Country:US
Mailing Address - Phone:919-846-9142
Mailing Address - Fax:919-846-9451
Practice Address - Street 1:6512 SIX FORKS RD
Practice Address - Street 2:STE 202A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6561
Practice Address - Country:US
Practice Address - Phone:919-846-9142
Practice Address - Fax:919-846-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2675103TC1900X
NC1427103TC1900X
NCC0003911041C0700X
NC008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02657OtherBCBS GROUP NUMBER
NC1410Medicare ID - Type UnspecifiedGROUP ID NUMBER