Provider Demographics
NPI:1235625666
Name:PELLEGRINI, ELIZABETH (LADC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PELLEGRINI
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DEVINNE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5900
Mailing Address - Country:US
Mailing Address - Phone:603-219-1824
Mailing Address - Fax:
Practice Address - Street 1:90 AIRPORT RD STE 17
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5326
Practice Address - Country:US
Practice Address - Phone:603-219-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1028101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)