Provider Demographics
NPI:1992116131
Name:PELTON, KERRI ELLEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:ELLEN
Last Name:PELTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:DORTICHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5115
Mailing Address - Country:US
Mailing Address - Phone:508-583-6498
Mailing Address - Fax:508-583-3775
Practice Address - Street 1:18 NEWTON ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5115
Practice Address - Country:US
Practice Address - Phone:508-583-6498
Practice Address - Fax:508-583-3775
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2169491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical