Provider Demographics
NPI:1265076012
Name:PERALTA-CALDERON, DIEGO ARMANDO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:ARMANDO
Last Name:PERALTA-CALDERON
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 1:233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4204
Mailing Address - Country:US
Mailing Address - Phone:860-224-8192
Mailing Address - Fax:860-224-6968
Practice Address - Street 1:233 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4204
Practice Address - Country:US
Practice Address - Phone:860-224-8192
Practice Address - Fax:860-224-6968
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional