Healthcare Provider Details

I. General information

NPI: 1730932732
Provider Name (Legal Business Name): PECA PSYCHOLOGIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WEST AVE STE 214
SARATOGA SPRINGS NY
12866-6077
US

IV. Provider business mailing address

203 LAKE AVE
LAKE LUZERNE NY
12846-2614
US

V. Phone/Fax

Practice location:
  • Phone: 518-331-0234
  • Fax:
Mailing address:
  • Phone: 518-331-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA PECA
Title or Position: OWNER
Credential: PH.D.
Phone: 518-331-0234