MEDICARE: PEGGY BERTUCCI LMHP, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	181	NE

General Provider Information

NPI Number	:	1548564339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY BERTUCCI LMHP, NCC

Provider Business Mailing Address
First Line	:	1710 N 144TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4715
Country	:	US
Telephone Number	:	402-885-3690
Fax Number	:	402-614-6174

Provider Business Practice Location Address
First Line	:	1710 N 144TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4715
Country	:	US
Telephone Number	:	402-885-3690
Fax Number	:	402-614-6174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/07/2011

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