Provider Demographics
NPI:1659621951
Name:PELLEGRINO, AZURE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:AZURE
Middle Name:
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2715
Mailing Address - Country:US
Mailing Address - Phone:559-313-8163
Mailing Address - Fax:
Practice Address - Street 1:614 HAMMOND ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2161
Practice Address - Country:US
Practice Address - Phone:617-505-6183
Practice Address - Fax:617-505-6184
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst