Active NPI
Brian Charles Peacock, PSYD
- Clinical Psychologist
- Berkeley, CA
National Provider Identifier
1194242230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 07046
- Practice address
- 1918 University Ave Ste 2B
Berkeley, CA 94704-3264 - Phone
- (609) 276-6305
- NPI assigned
- Aug 29, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 07046 | MD | Primary |
Addresses
Primary practice location
1918 University Ave Ste 2B
Berkeley, CA 94704-3264
Mailing address
1414 Key Hwy Ste 300P
Baltimore, MD 21230-5142
Phone (443) 565-6468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07046 | MD | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacock Psychology LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Baltimore, MD
- NPI 1003625377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735776000000",
"number": "1194242230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 KEY HWY STE 300P",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212305142",
"telephone_number": "443-565-6468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1918 UNIVERSITY AVE STE 2B",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947043264",
"telephone_number": "609-276-6305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "BRIAN",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-29",
"last_updated": "2025-01-02",
"certification_date": "2025-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "07046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.