Provider Demographics
NPI:1568828317
Name:PELLETIER, AMY LYNNE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNNE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LYNNE
Other - Last Name:ROISTACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:11432 TWINING LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1864
Mailing Address - Country:US
Mailing Address - Phone:301-651-9383
Mailing Address - Fax:
Practice Address - Street 1:6430 ROCKLEDGE DR STE 400
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1847
Practice Address - Country:US
Practice Address - Phone:301-881-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-10
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD097731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical