Provider Demographics
NPI:1316250889
Name:PELLEGRINI, ANDREA VIVIANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:VIVIANA
Last Name:PELLEGRINI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8688
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-8688
Mailing Address - Country:US
Mailing Address - Phone:786-683-9811
Mailing Address - Fax:800-398-9787
Practice Address - Street 1:3589 CANOPY CIR
Practice Address - Street 2:SUITE 190
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120
Practice Address - Country:US
Practice Address - Phone:786-683-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33972103TC0700X
FL9304103TC0700X
FLPY9304103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY9304OtherSTATE LICENSE