Provider Demographics
NPI:1033398862
Name:LEET PELLEGRINI, HELENA M (PHD)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:M
Last Name:LEET PELLEGRINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HELENA
Other - Middle Name:P
Other - Last Name:LEET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:61 SHERMAN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778
Mailing Address - Country:US
Mailing Address - Phone:508-358-5158
Mailing Address - Fax:508-358-0186
Practice Address - Street 1:61 SHERMAN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778
Practice Address - Country:US
Practice Address - Phone:508-358-5158
Practice Address - Fax:508-358-0186
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W02622OtherBCBS