Individual
MERANDA J PELLETIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC-C
Contact information
Practice address
22 MERCHANTS PLZ, BANGOR, ME 04401-6349
(207) 942-3816
(207) 942-9540
Mailing address
29 FRANKLIN ST, BANGOR, ME 04401-4909
(207) 942-3816
(207) 561-4725
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
XL3191
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098304
ANTHEM LEGACY NUMBER
ME
Enumeration date
02/05/2007
Last updated
07/09/2007
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