MEDICARE: MRS. ERICA LEE PECK MED

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1861627812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERICA LEE PECK MED

Provider Business Mailing Address
First Line	:	24 PEMI DR
Second Line	:
City	:	PLYMOUTH
State	:	NH
Zip	:	03264-4524
Country	:	US
Telephone Number	:	603-254-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 CHENELL DR STE 100
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-8514
Country	:	US
Telephone Number	:	603-545-8355
Fax Number	:

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	02/19/2024

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