Provider Demographics
NPI:1447536156
Name:PELLETIER, SHERRY (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-0509
Mailing Address - Country:US
Mailing Address - Phone:207-492-1653
Mailing Address - Fax:207-492-1633
Practice Address - Street 1:27 BIRDSEYE AVE
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-1620
Practice Address - Country:US
Practice Address - Phone:207-492-1653
Practice Address - Fax:207-492-1633
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5029101YA0400X
MELC144791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)