Provider Demographics
NPI:1811003403
Name:PELLETUR, JOYCE H (CLINICIAL COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:H
Last Name:PELLETUR
Suffix:
Gender:F
Credentials:CLINICIAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105
Mailing Address - Country:US
Mailing Address - Phone:207-797-5911
Mailing Address - Fax:207-797-5937
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:#203
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-797-5911
Practice Address - Fax:207-797-5937
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038036OtherANTHEM BLUE CROSS