Healthcare Provider Details

I. General information

NPI: 1104543388
Provider Name (Legal Business Name): CASEY PELLETIER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STAFFORD ST STE 305
SPRINGFIELD MA
01104-3500
US

IV. Provider business mailing address

300 STAFFORD ST STE 305
SPRINGFIELD MA
01104-3500
US

V. Phone/Fax

Practice location:
  • Phone: 413-539-2468
  • Fax: 413-539-2496
Mailing address:
  • Phone: 413-539-2468
  • Fax: 413-539-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12645
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: