Individual
MRS. VICTORIA GALE PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.I.S.W.
Contact information
Practice address
325 N BERGIN LN, BLOOMFIELD, NM 87413-6729
(505) 634-3863
Mailing address
2103 RANCH DR, FARMINGTON, NM 87401-2573
(505) 327-3283
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-06220
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84279567
—
NM
Enumeration date
05/21/2007
Last updated
07/09/2007
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