Provider Demographics
NPI:1417932633
Name:PECK, ROBERT F (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:F
Last Name:PECK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2649
Mailing Address - Country:US
Mailing Address - Phone:401-228-7914
Mailing Address - Fax:401-228-7916
Practice Address - Street 1:1255 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2649
Practice Address - Country:US
Practice Address - Phone:401-228-7914
Practice Address - Fax:401-228-7916
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW005881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI62-41317OtherUNITED HEALTHCARE
RI20786-3OtherBLUE CROSS OF RI
RI9020786Medicaid
RI62-41317OtherUNITED HEALTHCARE