Jessica Peck, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

05857 Issued in MD

Practice address

3261 Old Washington Rd Ste 2020
Waldorf, MD 20602-3231

Phone

(240) 780-8254

NPI assigned

Sep 5, 2012

Last updated

Sep 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jessica Samuelson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bluefish Behavioral Health

  • Community/Behavioral Health Agency
  • Waldorf, MD
  • NPI 1679206080
  NPD Authorized official
• Bluefish Therapy and Consulting, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockville, MD
  • NPI 1356816714
  NPD
• Della Behavioral Health Services

  dba CounterPoint Health Services

  • Psychologist
  • Columbia, MD
  • NPI 1750635207
  NPD

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1750630851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 575",
            "city": "PORT TOBACCO",
            "state": "MD",
            "postal_code": "206770575",
            "telephone_number": "240-780-8254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 OLD WASHINGTON RD STE 2020",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206023231",
            "telephone_number": "240-780-8254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "JESSICA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810007241",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "05857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SAMUELSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peace & Positivity Mental Health Services, LLC
• Peace of Mind Therapeutic Services, LLC
• Peacock Physical Therapy Services LLC
• Janine Peacock, D.P.T.
• Michael Edward Pearlman, DPM
• Pediatric Partners of Southern Maryland, PA
• Pediatric Speech Lab (Speech Lab ABA)
• Pediatric Speech Lab
• Pembrooke Anesthesia Assoc., LLC
• Pembrooke Health Services LLC (Pembrooke Pharmacy)

• Psychologist in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.