Healthcare Provider Details

I. General information

NPI: 1326572439
Provider Name (Legal Business Name): ALEXANDRA PELLETIER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HARTWELL ST
FALL RIVER MA
02721-3019
US

IV. Provider business mailing address

4 HARTWELL ST
FALL RIVER MA
02721-3019
US

V. Phone/Fax

Practice location:
  • Phone: 774-218-5440
  • Fax: 774-322-2255
Mailing address:
  • Phone: 774-218-5440
  • Fax: 774-322-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLICSW1143212
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: