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General NPI Number Information
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NPI Number | 1750630851
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Entity Type | Individual
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Provider Name | JESSICA PECK PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 3261 OLD WASHINGTON RD STE 2020
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City | WALDORF
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State | MD
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Zip | 20602-3231
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Country | US
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Telephone | 240-780-8254
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 575
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City | PORT TOBACCO
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State | MD
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Zip | 20677-0575
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Country | US
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Telephone | 240-780-8254
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810007241
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 05857
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License Number State | MD
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