Active NPI
Mary Ellen Peck, LCSW
- Mental Health Counselor
- Bay Shore, NY
National Provider Identifier
1497040406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 044226-1
- Practice address
- 260 Montauk Hwy, Suite 8
Bay Shore, NY 11706 - Phone
- (631) 647-9009
- NPI assigned
- Jun 17, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 044226-1 | NY | Primary |
Addresses
Primary practice location
260 Montauk Hwy, Suite 8
Bay Shore, NY 11706
Mailing address
48 Huntington Bay Rd
Huntington, NY 11743-2236
Phone (631) 424-2618
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 |
|---|---|---|---|
| 044226-1 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308268800000",
"number": "1497040406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 HUNTINGTON BAY RD",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117432236",
"telephone_number": "631-424-2618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "260 MONTAUK HWY, SUITE 8",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "11706",
"telephone_number": "631-647-9009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECK",
"first_name": "MARY ELLEN",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-17",
"last_updated": "2011-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "044226-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.