Provider Demographics
NPI:1831775949
Name:PEGNATARO, JUSTIN F (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:F
Last Name:PEGNATARO
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 WHITNEY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1973
Mailing Address - Country:US
Mailing Address - Phone:203-859-1953
Mailing Address - Fax:
Practice Address - Street 1:3496 WHITNEY AVE STE 202
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1973
Practice Address - Country:US
Practice Address - Phone:203-859-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017467101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health