Provider Demographics
NPI:1619693082
Name:PELLERITO, MARISA ANNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:ANNE
Last Name:PELLERITO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4619
Mailing Address - Country:US
Mailing Address - Phone:607-768-0281
Mailing Address - Fax:
Practice Address - Street 1:415 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4619
Practice Address - Country:US
Practice Address - Phone:607-768-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092013-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker