Healthcare Provider Details

I. General information

NPI: 1275302671
Provider Name (Legal Business Name): SAMANTHA PELLETIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WHITTIER CT
ANDOVER MA
01810-3809
US

IV. Provider business mailing address

23 CATHERINE DR
PEABODY MA
01960-3335
US

V. Phone/Fax

Practice location:
  • Phone: 207-347-0777
  • Fax:
Mailing address:
  • Phone: 207-347-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberLICSW1143157
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC23104
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: