Provider Demographics
NPI:1306154265
Name:PELLICELLI, CATHLENE A (BOARD CERTIFIED LMT)
Entity type:Individual
Prefix:
First Name:CATHLENE
Middle Name:A
Last Name:PELLICELLI
Suffix:
Gender:F
Credentials:BOARD CERTIFIED LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2531
Mailing Address - Country:US
Mailing Address - Phone:617-610-5022
Mailing Address - Fax:
Practice Address - Street 1:84 CLIFF AVE
Practice Address - Street 2:#1
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1532
Practice Address - Country:US
Practice Address - Phone:617-610-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT 2758-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist