Provider Demographics
NPI:1093098543
Name:PELLO, MARIANN ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIANN
Middle Name:ROSE
Last Name:PELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6318
Mailing Address - Country:US
Mailing Address - Phone:718-698-2351
Mailing Address - Fax:718-982-9044
Practice Address - Street 1:1480 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6318
Practice Address - Country:US
Practice Address - Phone:718-698-2351
Practice Address - Fax:718-982-9044
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 042989-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health