Provider Demographics
NPI:1649653205
Name:PELLIN, MICHELLE M (LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:PELLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BUTTONHOOK DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1375
Mailing Address - Country:US
Mailing Address - Phone:860-805-7819
Mailing Address - Fax:
Practice Address - Street 1:32 BUTTONHOOK DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1375
Practice Address - Country:US
Practice Address - Phone:860-805-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional