Provider Demographics
NPI:1366040073
Name:PELLEGRINO, MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 SEAMANS NECK RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1849
Mailing Address - Country:US
Mailing Address - Phone:516-698-8311
Mailing Address - Fax:
Practice Address - Street 1:1489 SEAMANS NECK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1849
Practice Address - Country:US
Practice Address - Phone:516-698-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency