Individual
DAVID PELLEGRINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCMHC
Contact information
Practice address
11 S MAIN ST, RANDOLPH, VT 05060-1330
(802) 728-4466
(802) 728-4197
Mailing address
20 FOREST ST, RANDOLPH, VT 05060-1007
(802) 728-4407
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068-0000170
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007038
—
VT
01
—
1041581
CIGNA
VT
01
—
14Y001678VT01
ANTHEM
VT
01
—
19428
BLUE CROSS
VT
Enumeration date
10/31/2006
Last updated
07/09/2007
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