Provider Demographics
NPI:1619189610
Name:PELLETIER, SARAH JEAN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JEAN
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 COLBY RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03819
Mailing Address - Country:US
Mailing Address - Phone:978-374-2700
Mailing Address - Fax:
Practice Address - Street 1:71 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830
Practice Address - Country:US
Practice Address - Phone:978-374-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1852752Medicaid
MAP07868OtherBLUE CROSS BLUE SHIELD
MA1852752Medicaid