Provider Demographics
NPI:1912915190
Name:HOOPER PEEK, GEORGIA (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:HOOPER PEEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 CROMPOND ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-739-7051
Mailing Address - Fax:914-739-7476
Practice Address - Street 1:2127 CROMPOND ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-739-7051
Practice Address - Fax:914-739-7476
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005023103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00945226Medicaid
NY00945226Medicaid