Provider Demographics
NPI:1952651432
Name:PEGNATARO, TANYA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:PEGNATARO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-1527
Mailing Address - Country:US
Mailing Address - Phone:860-460-1127
Mailing Address - Fax:
Practice Address - Street 1:165 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6397
Practice Address - Country:US
Practice Address - Phone:860-460-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health