Provider Demographics
NPI:1811369333
Name:PELLETIER, KEVIN (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BUTTERNUT RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-1511
Mailing Address - Country:US
Mailing Address - Phone:508-493-8494
Mailing Address - Fax:
Practice Address - Street 1:98 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6354
Practice Address - Country:US
Practice Address - Phone:508-879-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2211701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical