MEDICARE: CHANEL PEGERON LCSW

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	104100000X	Social Worker	100904	NY

General Provider Information

NPI Number	:	1942906607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANEL PEGERON LCSW

Provider Business Mailing Address
First Line	:	423 E 23RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-5011
Country	:	US
Telephone Number	:	646-659-8941
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 E 23RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-5011
Country	:	US
Telephone Number	:	646-659-8941
Fax Number	:

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

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/17/2026

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Directions to “ CHANEL PEGERON LCSW” Practice Location

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