Provider Demographics
NPI:1235270265
Name:MCCOY, CHRISTINE ALICE (MS, CCC, LSP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ALICE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MS, CCC, LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CEDAR GROVE TER
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1700
Mailing Address - Country:US
Mailing Address - Phone:631-816-5252
Mailing Address - Fax:
Practice Address - Street 1:12 CEDAR GROVE TER
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1700
Practice Address - Country:US
Practice Address - Phone:631-816-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008741-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist