Active NPI
Mary Mascolo Pellitteri, LADC
- Addiction (Substance Use Disorder) Counselor
- Derby, CT
National Provider Identifier
1245414440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 00364
- Practice address
- 130 Division Street
Griffin Hospital
Derby, CT 06418 - Phone
- (203) 732-7550
- Fax
- (203) 732-1550
- NPI assigned
- Dec 24, 2007
- Last updated
- May 16, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 00364 | CT | Primary |
Addresses
Primary practice location
130 Division Street
Griffin Hospital
Derby, CT 06418
Mailing address
130 Division Street
Griffin Hospital
Derby, CT 06418
Phone (203) 732-7550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00364 | Other | CT | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00364 | CT | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652659200000",
"number": "1245414440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 DIVISION STREET",
"address_2": "GRIFFIN HOSPITAL",
"city": "DERBY",
"state": "CT",
"postal_code": "06418",
"telephone_number": "203-732-7550",
"fax_number": "203-732-1550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 DIVISION STREET",
"address_2": "GRIFFIN HOSPITAL",
"city": "DERBY",
"state": "CT",
"postal_code": "06418",
"telephone_number": "203-732-7550",
"fax_number": "203-732-1550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLITTERI",
"first_name": "MARY",
"middle_name": "MASCOLO",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-24",
"last_updated": "2022-05-16",
"certification_date": "2022-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CT",
"license": "00364",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "00364",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Derby, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.