Provider Demographics
NPI:1861636193
Name:PELLETIER, COURTNEY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
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 1:1 EAST MAIN STREET SUITE 2
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833
Mailing Address - Country:US
Mailing Address - Phone:617-823-5512
Mailing Address - Fax:
Practice Address - Street 1:1 EAST MAIN STREET SUITE 2
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833
Practice Address - Country:US
Practice Address - Phone:617-823-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1166951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1031830OtherAETNA
MD1861636193OtherTEAMSTERS
MA1031830OtherBMC
MA1031830OtherNEIGHBORHOOD HEALTH PLAN
MA1031830OtherFALLON
MA1518164508OtherMBHP
MA1031830OtherBEACON
MA963959-01OtherNETWORD