Provider Demographics
NPI:1093027500
Name:PELLERIN, KRISTEN AMY
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AMY
Last Name:PELLERIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21A BOLIVAR ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3141
Mailing Address - Country:US
Mailing Address - Phone:978-618-8391
Mailing Address - Fax:
Practice Address - Street 1:460 TOTTEN POND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1991
Practice Address - Country:US
Practice Address - Phone:781-895-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst