Provider Demographics
NPI:1326204868
Name:PELLEGRINO, PHILIP J (PSYD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:PELLEGRINO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHLEHEM PLZ
Mailing Address - Street 2:SUITE 810
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5754
Mailing Address - Country:US
Mailing Address - Phone:610-865-4300
Mailing Address - Fax:610-865-4399
Practice Address - Street 1:1 BETHLEHEM PLZ
Practice Address - Street 2:SUITE 810
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5754
Practice Address - Country:US
Practice Address - Phone:610-865-4300
Practice Address - Fax:610-865-4399
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPS016995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health