Individual provider Active NPI

Peter J Peluso, LCSW-R

  • Clinical Social Worker
  • Malta, NY
National Provider Identifier
1215054234
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
079079 Issued in NY
Practice address
5 Hemphill Place
Suite 121
Malta, NY 12020-4423
Phone
(518) 289-5072
Fax
(518) 289-5225
NPI assigned
Mar 23, 2007
Last updated
Aug 30, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 079079 NY Primary

Addresses

Primary practice location

5 Hemphill Place
Suite 121
Malta, NY 12020-4423

Mailing address

5 Hemphill Place
Suite 121
Malta, NY 12020-4423
Phone (518) 289-5072

Other identifiers 1

IdentifierTypeStateIssuer
00639496MedicaidNY

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
I20230426000446 NY Order and Referring Only - Clinical Social Worker 7810155058

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
079079NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Union Street Counseling Services, LLC CurrentSince Oct 8, 2023 Accepting new patients

Locations

5 Hemphill Pl
Ste 121
Malta, NY 12020
Phone (518) 289-5072

Organizations & group practices 1

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": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1215054234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 HEMPHILL PLACE",
            "address_2": "SUITE 121",
            "city": "MALTA",
            "state": "NY",
            "postal_code": "120204423",
            "telephone_number": "518-289-5072",
            "fax_number": "518-289-5225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 HEMPHILL PLACE",
            "address_2": "SUITE 121",
            "city": "MALTA",
            "state": "NY",
            "postal_code": "120204423",
            "telephone_number": "518-289-5072",
            "fax_number": "518-289-5225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELUSO",
        "first_name": "PETER",
        "middle_name": "J",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "079079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00639496",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Malta, NY

Sources for this page

Verify at the official NPI Registry.