Provider Demographics
NPI:1881885838
Name:PEACOCK, CATHLEEN (MSW)
Entity type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 AURELIA CT
Mailing Address - Street 2:APT. 214
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3255
Mailing Address - Country:US
Mailing Address - Phone:718-855-7485
Mailing Address - Fax:718-855-1317
Practice Address - Street 1:40 RECTOR ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1705
Practice Address - Country:US
Practice Address - Phone:718-855-7485
Practice Address - Fax:718-855-1317
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070451-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health