Provider Demographics
NPI:1205028958
Name:PELLOT, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PELLOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 444 KM5 HC7
Mailing Address - Street 2:BO. ROCHA
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9711
Mailing Address - Country:US
Mailing Address - Phone:787-891-2360
Mailing Address - Fax:
Practice Address - Street 1:CARR 444 KM5 HC7
Practice Address - Street 2:BO. ROCHA
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9711
Practice Address - Country:US
Practice Address - Phone:787-891-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)