Provider Demographics
NPI:1851927396
Name:PELLEGRINO, BRETT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
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 1:19 KENNEDY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3532
Mailing Address - Country:US
Mailing Address - Phone:908-227-8893
Mailing Address - Fax:
Practice Address - Street 1:216 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1731
Practice Address - Country:US
Practice Address - Phone:732-639-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00624800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist