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General NPI Number Information
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NPI Number | 1518777119
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Entity Type | Individual
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Provider Name | GENESIS ILIANA PEGUERO MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1 WILDCAT WAY
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City | WEYMOUTH
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State | MA
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Zip | 02190-2664
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Country | US
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Telephone | 781-337-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 13 HUNTRESS AVE
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City | BROCKTON
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State | MA
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Zip | 02302-3934
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Country | US
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Telephone | 857-212-2025
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 127872
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License Number State | MA
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