Provider Demographics
NPI:1477121929
Name:PEGUERO, DANNY
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:PEGUERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 JOHNSON AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3539
Mailing Address - Country:US
Mailing Address - Phone:862-414-9395
Mailing Address - Fax:
Practice Address - Street 1:3265 JOHNSON AVE STE 212
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:862-414-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty