Provider Demographics
NPI:1902936222
Name:PEGUERO, DAYIMIRIS R (LCPC)
Entity Type:Individual
Prefix:
First Name:DAYIMIRIS
Middle Name:R
Last Name:PEGUERO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2508
Mailing Address - Country:US
Mailing Address - Phone:708-532-6951
Mailing Address - Fax:708-532-6952
Practice Address - Street 1:10450 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2508
Practice Address - Country:US
Practice Address - Phone:708-532-6951
Practice Address - Fax:708-532-6952
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
180005048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional