Healthcare Provider Details

I. General information

NPI: 1578497087
Provider Name (Legal Business Name): EMILY LYNN PECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 UNION ST
LAWRENCE MA
01840-1866
US

IV. Provider business mailing address

68 FERNVIEW AVE APT 4
NORTH ANDOVER MA
01845-4444
US

V. Phone/Fax

Practice location:
  • Phone: 978-684-2290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSA2490765
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: