Healthcare Provider Details

I. General information

NPI: 1205169356
Provider Name (Legal Business Name): ANNE MARIE PEGG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 GENESEE ST
BOWMANSVILLE NY
14026-1044
US

IV. Provider business mailing address

1526 WALDEN AVE STE 400
CHEEKTOWAGA NY
14225-4985
US

V. Phone/Fax

Practice location:
  • Phone: 716-681-5077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: