MEDICARE: MR. WILLIAM JOHN PECK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS 12801	CA

General Provider Information

NPI Number	:	1093884132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JOHN PECK

Provider Business Mailing Address
First Line	:	25915 SAN CLEMENTE DR
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2177
Country	:	US
Telephone Number	:	661-252-1734
Fax Number	:

Provider Business Practice Location Address
First Line	:	25915 SAN CLEMENTE DR
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2177
Country	:	US
Telephone Number	:	661-252-1734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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