Provider Demographics
NPI:1053484592
Name:VOGT, PEGGY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W NIPPON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2455
Mailing Address - Country:US
Mailing Address - Phone:215-620-4609
Mailing Address - Fax:
Practice Address - Street 1:313 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4908
Practice Address - Country:US
Practice Address - Phone:215-831-4811
Practice Address - Fax:215-831-2603
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW007160L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP48631Medicare UPIN
PAP48631Medicare UPIN