Provider Demographics
NPI:1962851360
Name:PELLEGRINO, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 OLD KENSICO RD
Mailing Address - Street 2:
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-2306
Mailing Address - Country:US
Mailing Address - Phone:914-925-5021
Mailing Address - Fax:
Practice Address - Street 1:715 OLD KENSICO RD
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-2306
Practice Address - Country:US
Practice Address - Phone:914-925-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral