Provider Demographics
NPI:1629770029
Name:PECK, GRAHAM (LMHC, MTBC)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:
Last Name:PECK
Suffix:
Gender:M
Credentials:LMHC, MTBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ELSINORE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2314
Mailing Address - Country:US
Mailing Address - Phone:978-505-2951
Mailing Address - Fax:
Practice Address - Street 1:18 LYMAN ST STE 250
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1472
Practice Address - Country:US
Practice Address - Phone:508-366-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16657225A00000X
MALMHC10005375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health