MEDICARE: MISS MEGAN KATHLEEN PETTIT MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	514	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PEP04631	OTHER	MA	BCBS OF MA
2	401001	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1942325840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEGAN KATHLEEN PETTIT MSW

Provider Business Mailing Address
First Line	:	PO BOX 1066
Second Line	:
City	:	DENNIS
State	:	MA
Zip	:	02638
Country	:	US
Telephone Number	:	508-385-9090
Fax Number	:	508-385-5060

Provider Business Practice Location Address
First Line	:	1420 MAIN ST.
Second Line	:
City	:	E. DENNIS
State	:	MA
Zip	:	02641
Country	:	US
Telephone Number	:	508-385-9090
Fax Number	:	508-385-5060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	11/23/2021

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