Healthcare Provider Details

I. General information

NPI: 1609218908
Provider Name (Legal Business Name): LAUREN E PELLETIER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2013
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 NEW BRITAIN AVE
HARTFORD CT
06106-3305
US

IV. Provider business mailing address

141 E MAIN ST
WATERBURY CT
06702-2310
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9300
  • Fax: 860-343-7379
Mailing address:
  • Phone: 203-574-9000
  • Fax: 203-574-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13740
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: