Peggy Defazio

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C3495 Issued in OR

Practice address

753 NW Brook St
Newport, OR 97365-3435

Phone

(541) 265-0884

NPI assigned

Jun 17, 2014

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Coastal Counseling & Consulting LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Newport, OR
  • NPI 1063020691

  Professional

  NPD Authorized official
• County of Lincoln

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Newport, OR
  • NPI 1740061878
  NPD (past)

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1356755326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1638 N COAST HWY",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973652357",
            "telephone_number": "541-819-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "753 NW BROOK ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973653435",
            "telephone_number": "541-265-0884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "218 W Olive St",
            "address_purpose": "LOCATION",
            "city": "Newport",
            "state": "OR",
            "postal_code": "973653813",
            "country_code": "US",
            "telephone_number": "541-265-0884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEFAZIO",
        "first_name": "PEGGY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-17",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C3495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Reid Davisworth II, QMHA
• Dawn Sly LCSW, Inc.
• Darcy De la Rosa, R.D., CDE
• Annalisa J Decina, LPC
• Jenny Kathleen Deen, R.D.H.
• Amy Lynn Dempsey, CMA
• Cedar Jane Derischebourg, HARM REDUCTION, QMHP
• Zemene Abuhay Desta, MSW, QMHP
• James Joseph Devaney, PMHCNS
• Melissa Ann Dewolfe, DO

• Professional Counselor in Newport, OR
• Providers in Newport, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.