Healthcare Provider Details

I. General information

NPI: 1447648746
Provider Name (Legal Business Name): FRANCISCO PEGUERO JR. NCCA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 ADELPHI ST APT1
BROOKLYN NY
11205-4009
US

IV. Provider business mailing address

214 ADELPHI ST. APT1
BROOKLYN NY
11205
US

V. Phone/Fax

Practice location:
  • Phone: 718-902-1568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number16168
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: