Provider Demographics
NPI:1811175581
Name:MCCOYD, JUDITH L M (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:L M
Last Name:MCCOYD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 DERWYN RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1202
Mailing Address - Country:US
Mailing Address - Phone:610-284-2287
Mailing Address - Fax:610-284-2287
Practice Address - Street 1:9 UNION AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3323
Practice Address - Country:US
Practice Address - Phone:610-284-2287
Practice Address - Fax:610-284-2287
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALCSW CW-00121231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0443130000OtherBLUE SHIELD