Healthcare Provider Details

I. General information

NPI: 1679425268
Provider Name (Legal Business Name): BENJAMIN PECK MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N PACIFIC COAST HWY STE 301
REDONDO BEACH CA
90277-2147
US

IV. Provider business mailing address

1050 S GRAMERCY DR
LOS ANGELES CA
90019-3607
US

V. Phone/Fax

Practice location:
  • Phone: 617-710-5769
  • Fax:
Mailing address:
  • Phone: 617-710-5769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: