Provider Demographics
NPI:1104965581
Name:PECK, TOBI ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:TOBI
Middle Name:ELIZABETH
Last Name:PECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:684 WASHINGTON ST
Mailing Address - Street 2:APT. 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2507
Mailing Address - Country:US
Mailing Address - Phone:212-613-3006
Mailing Address - Fax:212-691-8683
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:212-613-3006
Practice Address - Fax:212-691-8683
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0505871-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY143633OtherVALUE OPTIONS
NY278853POtherHIP HEALTH PLAN OF NY
NY7480180OtherGHI
NYP2626464OtherOXFORD
NYR050871-1OtherLCSW