Active NPI
Lisa Christine Pellegrin, PH.D.
- Clinical Psychologist
- Nashville, TN
National Provider Identifier
1972259489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2577
- Practice address
- 1412 17TH Ave S
Nashville, TN 37212-2804 - Phone
- (615) 823-3802
- NPI assigned
- Feb 23, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2577 | TN | Primary |
Addresses
Primary practice location
1412 17TH Ave S
Nashville, TN 37212-2804
Mailing address
1412 17TH Ave S
Nashville, TN 37212-2804
Phone (615) 823-3802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 12, 2026 through May 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2577 | TN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645574400000",
"number": "1972259489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1412 17TH AVE S",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372122804",
"telephone_number": "615-823-3802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 17TH AVE S",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372122804",
"telephone_number": "615-823-3802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLEGRIN",
"first_name": "LISA",
"middle_name": "CHRISTINE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-02-23",
"last_updated": "2022-02-23",
"certification_date": "2022-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "2577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nashville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.