Provider Demographics
NPI:1104543388
Name:PELLETIER, CASEY (LMHC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MILL ST STE 25
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-5409
Mailing Address - Country:US
Mailing Address - Phone:413-572-4421
Mailing Address - Fax:413-572-4139
Practice Address - Street 1:77 MILL ST STE 25
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-5409
Practice Address - Country:US
Practice Address - Phone:413-572-4421
Practice Address - Fax:413-572-4139
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health