Provider Demographics
NPI:1376026567
Name:PECK, JOEL THOMAS
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:THOMAS
Last Name:PECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4470
Mailing Address - Country:US
Mailing Address - Phone:860-740-3435
Mailing Address - Fax:860-344-3339
Practice Address - Street 1:230 MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4470
Practice Address - Country:US
Practice Address - Phone:860-740-3435
Practice Address - Fax:860-344-3339
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health