Provider Demographics
NPI:1336276195
Name:PELLEGRINO, JOSEPH F (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:PELLEGRINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 OTT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3222
Mailing Address - Country:US
Mailing Address - Phone:540-564-1982
Mailing Address - Fax:
Practice Address - Street 1:481 E MARKET ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4225
Practice Address - Country:US
Practice Address - Phone:540-574-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA085533OtherSENTARA OPTIMA
VA281942OtherANTHEM BLUE CROSS BS