Provider Demographics
NPI:1063488377
Name:MCCOY, THOMAS JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MCCOY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1303
Mailing Address - Country:US
Mailing Address - Phone:516-731-3248
Mailing Address - Fax:516-731-3248
Practice Address - Street 1:627 BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5031
Practice Address - Country:US
Practice Address - Phone:516-731-3248
Practice Address - Fax:516-731-3248
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO370691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05641Medicare ID - Type Unspecified
NYN1U611Medicare ID - Type Unspecified