MEDICARE: KARISSA PECKHAM

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	103K00000X	Behavior Analyst	1-24-72918	VT

General Provider Information

NPI Number	:	1801746375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISSA PECKHAM

Provider Business Mailing Address
First Line	:	123 JOEY DR
Second Line	:
City	:	COLCHESTER
State	:	VT
Zip	:	05446-3916
Country	:	US
Telephone Number	:	802-345-1447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1649 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2746
Country	:	US
Telephone Number	:	802-345-1447
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ KARISSA PECKHAM ” Practice Location

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