Provider Demographics
NPI:1124262407
Name:PEIKEN, MATTHEW E
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:PEIKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RADNOR RD
Mailing Address - Street 2:APT. 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5109
Mailing Address - Country:US
Mailing Address - Phone:617-968-5072
Mailing Address - Fax:617-968-5072
Practice Address - Street 1:265 BEACH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3131
Practice Address - Country:US
Practice Address - Phone:617-968-5072
Practice Address - Fax:617-968-5072
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical