Provider Demographics
NPI:1649010919
Name:PEACOCK, GIOVANNA (LAC)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4252
Mailing Address - Country:US
Mailing Address - Phone:646-571-6252
Mailing Address - Fax:
Practice Address - Street 1:123 HOW LN
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3653
Practice Address - Country:US
Practice Address - Phone:732-565-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00694700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional