Healthcare Provider Details

I. General information

NPI: 1164748331
Provider Name (Legal Business Name): MELISSA E PELLEGRINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1295
US

IV. Provider business mailing address

9099 MAIL SERVICE CTR APT 1956
RALEIGH NC
27699-9000
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7722
  • Fax:
Mailing address:
  • Phone: 919-451-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075415
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009128
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: