Provider Demographics
NPI:1790472405
Name:PEGUERO, LEE-ANN (RBT)
Entity Type:Individual
Prefix:
First Name:LEE-ANN
Middle Name:
Last Name:PEGUERO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4464 WYNDCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3316
Mailing Address - Country:US
Mailing Address - Phone:321-310-3826
Mailing Address - Fax:
Practice Address - Street 1:4464 WYNDCLIFF CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3316
Practice Address - Country:US
Practice Address - Phone:321-310-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-269645106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician