Provider Demographics
NPI:1467568170
Name:PECK, JAMES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:PECK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 WILSHIRE BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4748
Mailing Address - Country:US
Mailing Address - Phone:310-279-2976
Mailing Address - Fax:310-828-7311
Practice Address - Street 1:2730 WILSHIRE BLVD STE 550
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4748
Practice Address - Country:US
Practice Address - Phone:310-279-2976
Practice Address - Fax:310-828-7311
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY190760OtherMEDICAL
CAWCP19076AMedicare ID - Type Unspecified
CAPSY190760OtherMEDICAL