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Individual

EDWARD ARNOLD PECK III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
2010 BREMO RD, SUITE 127, RICHMOND, VA 23226-2444
(804) 285-2555
(804) 282-0314
Mailing address
2010 BREMO RD, SUITE 127, RICHMOND, VA 23226-2444
(804) 285-2555
(804) 282-0314

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
0810000910
VA
103TC0700X
Clinical Psychologist
0810000910
VA
103TC0700X
Clinical Psychologist
2228
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
007705948
VA
01
018091
ANTHEM BCBS
VA
01
087976
SENTARA MENTAL HEALTH
VA
Enumeration date
05/25/2006
Last updated
10/16/2008
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