Provider Demographics
NPI:1043554728
Name:PELLEGRINO, JENNIFER K (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W 29TH ST RM 703
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5326
Mailing Address - Country:US
Mailing Address - Phone:212-564-7631
Mailing Address - Fax:
Practice Address - Street 1:214 W 29TH ST RM 703
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5326
Practice Address - Country:US
Practice Address - Phone:212-564-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005222-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005222-1OtherLICENSE NUMBER