Provider Demographics
NPI:1154166031
Name:MCCOY-STUBBS, DELIA ROSE
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:ROSE
Last Name:MCCOY-STUBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 FRIENDLY RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3108
Mailing Address - Country:US
Mailing Address - Phone:203-892-3693
Mailing Address - Fax:
Practice Address - Street 1:300 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1103
Practice Address - Country:US
Practice Address - Phone:203-275-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker