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General NPI Number Information
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NPI Number | 1497628770
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Entity Type | Organization
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Legal Business Name | TARA PELLEGRINO LLC
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 51 UPPER MONTCLAIR PLZ STE 26
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1340
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Country | US
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Telephone | 973-283-5896
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Fax |
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Provider Business Mailing Address
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Address Line | 9 LANSING PL
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1406
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Country | US
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Telephone | 973-919-3925
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARA PELLEGRINO
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Credential |
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Telephone | 973-919-3925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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