Basic Information
| Provider Information | |||||||||
| NPI: | 1164748331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELLEGRINO | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9099 MAIL SERVICE CTR APT 1956 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276999000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194514966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3000 NEW BERN AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276101295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193507722 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2010 | ||||||||
| LastUpdateDate: | 02/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 075415 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C009128 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.