Provider Demographics
NPI:1205105111
Name:COUFAL-CURNUTT, PEGGY (LCSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:COUFAL-CURNUTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4738
Mailing Address - Country:US
Mailing Address - Phone:516-377-9248
Mailing Address - Fax:
Practice Address - Street 1:841 ETHEL T KLOBERG DR
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2433
Practice Address - Country:US
Practice Address - Phone:516-377-9248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool