Provider Demographics
NPI:1134274038
Name:PELLEGRIN, ALICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:PELLEGRIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10517 KENTSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2853
Mailing Address - Country:US
Mailing Address - Phone:225-769-8335
Mailing Address - Fax:225-769-8396
Practice Address - Street 1:10517 KENTSHIRE CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2853
Practice Address - Country:US
Practice Address - Phone:225-769-8335
Practice Address - Fax:225-769-8396
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA751103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist