Provider Demographics
NPI:1790045383
Name:PECKHEISER, PAMELA SUE (MA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:PECKHEISER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:ALLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:250 POST RD E
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3616
Mailing Address - Country:US
Mailing Address - Phone:203-246-0748
Mailing Address - Fax:
Practice Address - Street 1:250 POST RD E
Practice Address - Street 2:SUITE 110A
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3616
Practice Address - Country:US
Practice Address - Phone:203-246-0748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist