Provider Demographics
NPI:1992730485
Name:MCCOY, MONIKA E (PHD)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:E
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2121
Mailing Address - Country:US
Mailing Address - Phone:818-790-9448
Mailing Address - Fax:818-248-7520
Practice Address - Street 1:1369 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2121
Practice Address - Country:US
Practice Address - Phone:818-790-9448
Practice Address - Fax:818-248-7520
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12695Medicare ID - Type Unspecified