Provider Demographics
NPI:1679254874
Name:PELLEGRINO, OLIVIA ROSE (LMHC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ROSE
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 ATWOOD AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4930
Mailing Address - Country:US
Mailing Address - Phone:401-241-3344
Mailing Address - Fax:401-563-8656
Practice Address - Street 1:1395 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4929
Practice Address - Country:US
Practice Address - Phone:401-241-3344
Practice Address - Fax:401-563-8656
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty