Provider Demographics
NPI:1093069262
Name:PELLEGRINO, NORA (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1841
Mailing Address - Country:US
Mailing Address - Phone:888-966-0746
Mailing Address - Fax:
Practice Address - Street 1:316 W WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-1841
Practice Address - Country:US
Practice Address - Phone:888-966-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-12-11736103K00000X
NJ35S100568300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst