Provider Demographics
NPI:1861407272
Name:SPECK, PHOEBE B (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:B
Last Name:SPECK
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:DR
Other - First Name:PHOEBE
Other - Middle Name:B
Other - Last Name:OFFICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LICSW
Mailing Address - Street 1:225 MOORLAND RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2421
Mailing Address - Country:US
Mailing Address - Phone:508-540-7107
Mailing Address - Fax:508-540-7107
Practice Address - Street 1:225 MOORLAND RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2421
Practice Address - Country:US
Practice Address - Phone:508-540-7107
Practice Address - Fax:508-540-7107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1133791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical