MEDICARE: JASMINE PECK LCSW PLLC

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

General Provider Information

NPI Number	:	1780522870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASMINE PECK LCSW PLLC

Provider Business Mailing Address
First Line	:	4900 STATE ROUTE 31
Second Line	:
City	:	VERNON
State	:	NY
Zip	:	13476-3839
Country	:	US
Telephone Number	:	315-918-7521
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 STATE ROUTE 31
Second Line	:
City	:	VERNON
State	:	NY
Zip	:	13476-3839
Country	:	US
Telephone Number	:	315-918-7521
Fax Number	:

Authorized Official
Title or Position	:	LCSW/OWNDER
Name	:	JASMINE PECK
Credential	:	LCSW, LICSW
Telephone Number	:	315-918-7521

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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