Provider Demographics
NPI:1588707004
Name:PECKINS, CAROL SUSAN (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUSAN
Last Name:PECKINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:SUSAN
Other - Last Name:KLAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MSW
Mailing Address - Street 1:45 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1322
Mailing Address - Country:US
Mailing Address - Phone:978-352-7889
Mailing Address - Fax:
Practice Address - Street 1:45 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-1322
Practice Address - Country:US
Practice Address - Phone:978-352-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical