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General NPI Number Information
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NPI Number | 1316243702
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Entity Type | Individual
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Provider Name | MARK PELUSO LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 400 N STATE ROAD 19 STE 48
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City | PALATKA
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State | FL
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Zip | 32177-2449
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Country | US
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Telephone | 386-329-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 1177 SILAS DEANE HWY
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4348
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Country | US
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Telephone | 860-704-9313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007552
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License Number State | CT
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