Provider Demographics
NPI:1326204868
Name:PELLEGRINO, PHILIP J (PSYD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:PELLEGRINO
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ASHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8688
Mailing Address - Country:US
Mailing Address - Phone:610-936-8470
Mailing Address - Fax:
Practice Address - Street 1:623 W UNION BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3708
Practice Address - Country:US
Practice Address - Phone:610-936-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPS016995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health