Khadijah G Peguero, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

103471 Issued in NY

Practice address

302 W 91St St Apt 2
New York, NY 10024-1011

Phone

(212) 787-7120

Fax

(212) 580-0533

NPI assigned

Oct 12, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Service Program for Older People, Inc

  • Geriatric Psychiatry Physician
  • New York, NY
  • NPI 1740211143
  NPD
• Service Program for Older People

  • Community/Behavioral Health Agency
  • New York, NY
  • NPI 1831644657
  NPD (past)

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1275259285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W 91ST ST APT 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100241011",
            "telephone_number": "212-787-7120",
            "fax_number": "212-580-0533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W 91ST ST APT 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100241011",
            "telephone_number": "212-787-7120",
            "fax_number": "212-580-0533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEGUERO",
        "first_name": "KHADIJAH",
        "middle_name": "G",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-12",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "103471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMSW LICENSE",
            "identifier": "111633",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Camila Peguero Peralta
• Corina Peguero-Gonzalez
• Anderson Peguero II, LMSW
• Ivelise A Peguero, CLINICAL LAB TECH
• Janet Peguero, LCSW
• Natasha R Peguero
• Reina Peguero
• Wendy Esperanza Peguero, LMSW
• Mary Pegues, P.A.
• Patricia Maria Pehme

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.