Marti Ellen Peck, MARTI PECK, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY12131 Issued in CA

Practice address

2251 San Diego Ave
Suite B253
San Diego, CA 92110-2926

Phone

(619) 291-9164

Fax

(619) 291-9953

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Martha Ellen Peck Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2013 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710929856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 SAN DIEGO AVE",
            "address_2": "SUITE B253",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102926",
            "telephone_number": "619-291-9164",
            "fax_number": "619-291-9953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 SAN DIEGO AVE",
            "address_2": "SUITE B253",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102926",
            "telephone_number": "619-291-9164",
            "fax_number": "619-291-9953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "MARTI",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "MARTI PECK, PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY12131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARTHA",
            "last_name": "PECK",
            "middle_name": "ELLEN",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Annalyn Pecjo Baysa
• Jill A. Peck-Murray, OTR
• Stephanie Peck-Wheeler, PHARM.D.
• Jamin Daniel Peck
• Kimberly A Peck, MD
• Stephanie Knatz Peck, PH.D.
• Beth Ann Peckham, L.AC.
• Maggie Peddicord, RD RDN
• Monica Lea Peddicord, CADC-II
• Alexandra K Pedersen

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.