MEDICARE: DR. MICHAEL L PECK PHD

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	103TC0700X	Clinical Psychologist	PSY2942	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY2942	OTHER	CA	PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1740328491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL L PECK PHD

Provider Business Mailing Address
First Line	:	10642 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4525
Country	:	US
Telephone Number	:	310-475-3018
Fax Number	:	310-475-3018

Provider Business Practice Location Address
First Line	:	10642 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4525
Country	:	US
Telephone Number	:	310-475-3018
Fax Number	:	310-475-3018

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

Similar Medicare Providers

1427094135 — NONA WILLIAMS PSY.D.
Practice Location Address:

10642 SANTA MONICA BLVD , SUITE 201
LOS ANGELES, CA
90025-4525

Practice Phone: 310-433-1379
Practice Fax:

1871638239 — MS. JENNIFER MARIE WILLEMSEN LMFT
Practice Location Address:

10642 SANTA MONICA BLVD , SUITE 201
LOS ANGELES, CA
90025-4525

Practice Phone: 310-470-9016
Practice Fax: 310-470-3169

1376737213 — MR. PAUL MICHAEL REMMELE LMFT
Practice Location Address:

10642 SANTA MONICA BLVD , SUITE #201
LOS ANGELES, CA
90025-4525

Practice Phone: 310-475-9620
Practice Fax:

1669709119 — ALYCE BOTWINICK LCSW
Practice Location Address:

10642 SANTA MONICA BLVD , SUITE 201
LOS ANGELES, CA
90025-4525

Practice Phone: 310-470-9016
Practice Fax: 310-470-3169

1700113248 — ERIC DANIEL KASTAN LMFT
Practice Location Address:

10642 SANTA MONICA BLVD , SUITE 201
LOS ANGELES, CA
90025-4525

Practice Phone: 310-470-9016
Practice Fax: 310-470-3169

1790181691 — PEDIATRIC THERAPY PLAYHOUSE
Practice Location Address:

10642 SANTA MONICA BLVD , SUITE 101
LOS ANGELES, CA
90025-4525

Practice Phone: 310-571-5726
Practice Fax:

Directions to “ DR. MICHAEL L PECK PHD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.