Provider Demographics
NPI:1598710220
Name:DELERY, PEGGY MARIE (LCSW-BACS, C-SSWS)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:MARIE
Last Name:DELERY
Suffix:
Gender:F
Credentials:LCSW-BACS, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 W IMPERIAL AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2047
Mailing Address - Country:US
Mailing Address - Phone:310-765-3322
Mailing Address - Fax:310-765-3322
Practice Address - Street 1:483 N AVIATION BLVD
Practice Address - Street 2:61 MDS/SGOH
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2808
Practice Address - Country:US
Practice Address - Phone:310-653-6860
Practice Address - Fax:310-653-6737
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical