Provider Demographics
NPI:1417229071
Name:PECK, JUDITH STERN (MSW,)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:STERN
Last Name:PECK
Suffix:
Gender:F
Credentials:MSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 5TH AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1749
Mailing Address - Country:US
Mailing Address - Phone:212-794-1496
Mailing Address - Fax:
Practice Address - Street 1:952 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1740
Practice Address - Country:US
Practice Address - Phone:212-794-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR021795-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist