Provider Demographics
NPI:1164436242
Name:PELLEGRINI, NANCY L (MSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:PELLEGRINI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SHEA LN
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-9508
Mailing Address - Country:US
Mailing Address - Phone:610-458-8270
Mailing Address - Fax:
Practice Address - Street 1:160 SHEA LN
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-9508
Practice Address - Country:US
Practice Address - Phone:610-327-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-001889-E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S32686Medicare UPIN
687963Medicare ID - Type Unspecified