Provider Demographics
NPI:1851559587
Name:PECK, DOUGLAS ANDREW (LMHC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:PECK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HARRISON AVE STE 208D
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3150
Mailing Address - Country:US
Mailing Address - Phone:914-500-9892
Mailing Address - Fax:914-828-0072
Practice Address - Street 1:1600 HARRISON AVE STE 208D
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3150
Practice Address - Country:US
Practice Address - Phone:914-500-9892
Practice Address - Fax:914-828-0072
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health