MEDICARE: CAROLYN PEGUERO SPENCER MA, LCSW

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	1041C0700X	Clinical Social Worker	44SC05426400	NJ

General Provider Information

NPI Number	:	1467754820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN PEGUERO SPENCER MA, LCSW

Provider Business Mailing Address
First Line	:	42 BARNEGAT RD
Second Line	:
City	:	HEWITT
State	:	NJ
Zip	:	07421-3841
Country	:	US
Telephone Number	:	973-647-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 KINGS HWY STE 3A
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918-3140
Country	:	US
Telephone Number	:	973-647-4905
Fax Number	:

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	03/17/2020

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