Provider Demographics
NPI:1447521802
Name:PECK, FIONA N (MA)
Entity type:Individual
Prefix:
First Name:FIONA
Middle Name:N
Last Name:PECK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 DOCKSIDE DR
Mailing Address - Street 2:APT D
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6936
Mailing Address - Country:US
Mailing Address - Phone:954-415-5426
Mailing Address - Fax:
Practice Address - Street 1:1527 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1035
Practice Address - Country:US
Practice Address - Phone:954-835-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health