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General NPI Number Information
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NPI Number | 1497538292
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Entity Type | Individual
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Provider Name | LUIS E RUIZPEGUERO LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1251 FAIRFAX HUNT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4003
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Country | US
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Telephone | 912-977-3941
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Fax |
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Provider Business Mailing Address
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Address Line | 8735 DUNWOODY PL # 5032
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City | ATLANTA
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State | GA
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Zip | 30350-2995
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Country | US
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Telephone | 404-692-3539
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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 | CSW008698
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License Number State | GA
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