Provider Demographics
NPI:1558925024
Name:PEGUERO, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
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 1:484 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1409
Mailing Address - Country:US
Mailing Address - Phone:774-318-1806
Mailing Address - Fax:508-479-5389
Practice Address - Street 1:484 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1409
Practice Address - Country:US
Practice Address - Phone:774-318-1806
Practice Address - Fax:508-479-5389
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician