Provider Demographics
NPI:1912934092
Name:PELLEGRINI, WAYNE LOUIS (PHD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:LOUIS
Last Name:PELLEGRINI
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 1:160 SHEA LN
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-9508
Mailing Address - Country:US
Mailing Address - Phone:610-458-8270
Mailing Address - Fax:
Practice Address - Street 1:600 CREEKSIDE DR
Practice Address - Street 2:SUITE 609
Practice Address - City:SANATOGA
Practice Address - State:PA
Practice Address - Zip Code:19464-9204
Practice Address - Country:US
Practice Address - Phone:610-458-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005410-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical