Provider Demographics
NPI:1659307635
Name:PECK, PAMELA NAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:NAN
Last Name:PECK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3106
Mailing Address - Country:US
Mailing Address - Phone:617-667-0651
Mailing Address - Fax:
Practice Address - Street 1:37 ELM ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3106
Practice Address - Country:US
Practice Address - Phone:617-667-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical