Healthcare Provider Details

I. General information

NPI: 1124908488
Provider Name (Legal Business Name): PALOMA PELLEGRINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CHANDLER ST
WORCESTER MA
01602-3441
US

IV. Provider business mailing address

335 CHANDLER ST
WORCESTER MA
01602-3441
US

V. Phone/Fax

Practice location:
  • Phone: 857-333-7668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: