Individual provider Active NPI

Corina Peguero-Gonzalez

  • Mental Health Counselor
  • New York, NY
National Provider Identifier
1013668011
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
015481 Issued in NY
Practice address
733 3Rd Ave
New York, NY 10017-3204
Phone
(646) 450-3064
NPI assigned
Jan 12, 2022
Last updated
Jan 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X 015481 NY Primary

Addresses

Primary practice location

733 3Rd Ave
New York, NY 10017-3204

Mailing address

52 James Wilkinson Rd
Rock Tavern, NY 12575-5321
Phone (914) 819-3308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260424001627 NY Practitioner - Mental Health Counselor 9739656927 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

400 S Colorado Blvd
Suite 590
Denver, CO 80246-1252

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
015481NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Psychological Wellness, PLLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

115 E 23rd St
Fl 3
New York, NY 10010
Phone (646) 450-3064

733 3rd Ave
New York, NY 10017
Phone (646) 450-3064

733 3rd Ave
Fl 16
New York, NY 10017
Phone (646) 450-3064

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1013668011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 JAMES WILKINSON RD",
            "city": "ROCK TAVERN",
            "state": "NY",
            "postal_code": "125755321",
            "telephone_number": "914-819-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 3RD AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100173204",
            "telephone_number": "646-450-3064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEGUERO-GONZALEZ",
        "first_name": "CORINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-12",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "015481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.