Provider Demographics
NPI:1154557270
Name:PECK, JASON ROBERT (MA, CAGS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:PECK
Suffix:
Gender:M
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BARR ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-1804
Mailing Address - Country:US
Mailing Address - Phone:978-257-5217
Mailing Address - Fax:
Practice Address - Street 1:8 BARR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-1804
Practice Address - Country:US
Practice Address - Phone:978-257-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA378295103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool