Provider Demographics
NPI:1497538292
Name:RUIZPEGUERO, LUIS E (LCSW)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:RUIZPEGUERO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 FAIRFAX HUNT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4003
Mailing Address - Country:US
Mailing Address - Phone:912-977-3941
Mailing Address - Fax:
Practice Address - Street 1:1251 FAIRFAX HUNT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4003
Practice Address - Country:US
Practice Address - Phone:912-977-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0086981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty