Provider Demographics
NPI:1821284332
Name:PECK, KATHLEEN (MSW,LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:KATONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,LICSW
Mailing Address - Street 1:99 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1213
Mailing Address - Country:US
Mailing Address - Phone:617-587-1500
Mailing Address - Fax:
Practice Address - Street 1:231 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4342
Practice Address - Country:US
Practice Address - Phone:508-586-2660
Practice Address - Fax:508-427-1505
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1004931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical