Healthcare Provider Details

I. General information

NPI: 1518321090
Provider Name (Legal Business Name): KATHLEEN ELIZABETH PELLECCHIA MSW, LMSW-CC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MID COAST DR
BELFAST ME
04915-6079
US

IV. Provider business mailing address

15 MID COAST DR
BELFAST ME
04915-6079
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-2295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC24164
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number231216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: