Individual
MARY MASCOLO PELLITTERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
130 DIVISION STREET, GRIFFIN HOSPITAL, DERBY, CT 06418
(203) 732-7550
(203) 732-1550
Mailing address
130 DIVISION STREET, GRIFFIN HOSPITAL, DERBY, CT 06418
(203) 732-7550
(203) 732-1550
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00364
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00364
LICENSE NUMBER
CT
Enumeration date
12/24/2007
Last updated
05/16/2022
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