Provider Demographics
NPI:1184858870
Name:PECK, MISCHA COHEN (MA, MSW, PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MISCHA
Middle Name:COHEN
Last Name:PECK
Suffix:
Gender:M
Credentials:MA, MSW, PHD, LCSW
Other - Prefix:
Other - First Name:MISCHA
Other - Middle Name:COHEN
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MICHAEL DAVID PECK
Mailing Address - Street 1:2030 N DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2123
Mailing Address - Country:US
Mailing Address - Phone:602-570-2373
Mailing Address - Fax:
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-570-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-127421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical