Healthcare Provider Details

I. General information

NPI: 1316250889
Provider Name (Legal Business Name): ANDREA VIVIANA PELLEGRINI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 04/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3589 CANOPY CIR SUITE 190
NAPLES FL
34120
US

IV. Provider business mailing address

PO BOX 8688
NAPLES FL
34101-8688
US

V. Phone/Fax

Practice location:
  • Phone: 786-683-9811
  • Fax:
Mailing address:
  • Phone: 786-683-9811
  • Fax: 800-398-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33972
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9304
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY9304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: