MEDICARE: MS. ELIZABETH SUSAN PELLEGRINO LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH4976	FL

General Provider Information

NPI Number	:	1023246931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH SUSAN PELLEGRINO LMHC

Provider Business Mailing Address
First Line	:	631 RIVERSIDE RD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3726
Country	:	US
Telephone Number	:	561-718-8715
Fax Number	:	561-840-9399

Provider Business Practice Location Address
First Line	:	631 RIVERSIDE RD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3726
Country	:	US
Telephone Number	:	561-718-8715
Fax Number	:	561-840-9399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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