Provider Demographics
NPI:1679764302
Name:PELLETIER, ERIN R (LICSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:R
Last Name:PELLETIER
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 1:119 WAREHAM RD
Mailing Address - Street 2:STE 104
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1178
Mailing Address - Country:US
Mailing Address - Phone:508-748-3131
Mailing Address - Fax:508-748-3137
Practice Address - Street 1:119 WAREHAM RD
Practice Address - Street 2:STE 104
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1178
Practice Address - Country:US
Practice Address - Phone:508-748-3131
Practice Address - Fax:508-748-3137
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical