Provider Demographics
NPI:1124882881
Name:MCCOY, MADAM LATOYA
Entity type:Individual
Prefix:
First Name:MADAM
Middle Name:LATOYA
Last Name:MCCOY
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 1:919 MYRTLE AVE APT 1H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6549
Mailing Address - Country:US
Mailing Address - Phone:929-422-4248
Mailing Address - Fax:
Practice Address - Street 1:22222 92ND RD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1453
Practice Address - Country:US
Practice Address - Phone:516-252-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst