Provider Demographics
NPI:1043786031
Name:PECK, JENNIFER (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-8721
Mailing Address - Country:US
Mailing Address - Phone:717-567-3524
Mailing Address - Fax:717-567-3581
Practice Address - Street 1:28 W SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8721
Practice Address - Country:US
Practice Address - Phone:717-567-3524
Practice Address - Fax:717-567-3581
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW022634104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker