Provider Demographics
NPI:1184399032
Name:PEGUERO, MABEL
Entity type:Individual
Prefix:MISS
First Name:MABEL
Middle Name:
Last Name:PEGUERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAPLE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2223
Mailing Address - Country:US
Mailing Address - Phone:413-377-6400
Mailing Address - Fax:
Practice Address - Street 1:120 MAPLE ST STE 301
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2223
Practice Address - Country:US
Practice Address - Phone:413-377-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical