Provider Demographics
NPI:1306617568
Name:PECKHAM, SAMANTHA (PMHNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3206
Mailing Address - Country:US
Mailing Address - Phone:610-638-6738
Mailing Address - Fax:610-672-6181
Practice Address - Street 1:116 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3206
Practice Address - Country:US
Practice Address - Phone:610-638-6738
Practice Address - Fax:610-672-6181
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029109363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health