Provider Demographics
NPI:1992489777
Name:PELLETIER, LEE FREEMAN (MA, MDIV)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:FREEMAN
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 REID ST
Mailing Address - Street 2:
Mailing Address - City:FORT PLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:13339-1336
Mailing Address - Country:US
Mailing Address - Phone:518-490-9199
Mailing Address - Fax:518-309-6884
Practice Address - Street 1:1 REID ST
Practice Address - Street 2:
Practice Address - City:FORT PLAIN
Practice Address - State:NY
Practice Address - Zip Code:13339-1336
Practice Address - Country:US
Practice Address - Phone:518-490-9199
Practice Address - Fax:518-309-6884
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty