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General NPI Number Information
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NPI Number | 1467754820
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Entity Type | Individual
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Provider Name | CAROLYN PEGUERO SPENCER MA, LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 1108 KINGS HWY STE 3A
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City | CHESTER
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State | NY
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Zip | 10918-3140
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Country | US
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Telephone | 973-647-4905
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Fax |
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Provider Business Mailing Address
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Address Line | 42 BARNEGAT RD
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City | HEWITT
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State | NJ
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Zip | 07421-3841
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Country | US
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Telephone | 973-647-4905
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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 | 44SC05426400
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License Number State | NJ
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