Provider Demographics
NPI:1659357150
Name:PELAVIN, ANNE KAY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:KAY
Last Name:PELAVIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2025
Mailing Address - Country:US
Mailing Address - Phone:978-388-7570
Mailing Address - Fax:
Practice Address - Street 1:150 MERRIMAC ST
Practice Address - Street 2:MOON SPIRIT
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2357
Practice Address - Country:US
Practice Address - Phone:978-388-7570
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical