| Doctor Name: | GINA VINCENZA PEACOCK |
| NPI Number: | 1164714606 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 00082239 |
| Business Practice Address: | 3043 State Route 4 Hudson Falls, NY - 128399632 |
| Business Phone Number: | 5187472284 |
| Business Fax Number: | 5187472253 |
| Mailing Address: | 3043 State Route 4, HUDSON FALLS |
| State: | NY |
| Postal Code: | 128399632 |
| Phone Number: | 5187472284 |
| Fax Number: | 5187472253 |
| NPI Enumeration Date: | 05/03/2011 |
| NPI Last Update Date: | 03/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 00082239 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |