ETHAN PEMBERTON
NPI 1306486204
Social Worker - Clinical in Grand Rapids, MI

Active since January 09, 2020
206 FULLER AVE SE, GRAND RAPIDS, MI 49506(810) 347-2159 Get Directions Write a Review

NPPES record last updated: June 12, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ethan Pemberton NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN PEMBERTON (NPI 1306486204) is an individual clinical provider in Grand Rapids, Michigan and active in the NPI registry since January 2020.

NPPES Registry Identity

NPI1306486204
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameETHAN PEMBERTON
Location Address206 FULLER AVE SEGrand Rapids, MI 49506-1638
Mailing Address206 Fuller Ave SeGrand Rapids, MI 49506-1638 · (810) 347-2159
Sole ProprietorYes
Enumeration DateJanuary 9, 2020
Last NPPES UpdateJune 12, 2026
NPPES CertifiedJune 12, 2026
NPI 1306486204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
206 FULLER AVE SE, Grand Rapids, MI 49506

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Pemberton's NPI number?

The NPI number for Ethan Pemberton is 1306486204. It was assigned to this individual provider in the NPPES registry on January 9, 2020.

Where is Ethan Pemberton located?

Ethan Pemberton practices at 206 Fuller Ave SE, Grand Rapids, MI 49506. The listed phone number is (810) 347-2159.

What is Ethan Pemberton's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Ethan Pemberton was last updated on June 12, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.