Provider Demographics
NPI:1801674338
Name:PEREGRIN DELGADO, MABEL LINAIRIS
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:LINAIRIS
Last Name:PEREGRIN DELGADO
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 1:45 ERIEVIEW PLZ APT 1123
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1904
Mailing Address - Country:US
Mailing Address - Phone:786-290-8195
Mailing Address - Fax:786-866-2801
Practice Address - Street 1:22901 MILLCREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5701
Practice Address - Country:US
Practice Address - Phone:786-290-8195
Practice Address - Fax:786-866-2801
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
OHRES004909390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical