Provider Demographics
NPI:1326412396
Name:MCCOVERY, CHICQUITA LAQUANDA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CHICQUITA
Middle Name:LAQUANDA
Last Name:MCCOVERY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:CHICQUITA
Other - Middle Name:LAQUANDA
Other - Last Name:MCCOVERY-MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:195 TRANTOR PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-1926
Mailing Address - Country:US
Mailing Address - Phone:718-541-2046
Mailing Address - Fax:
Practice Address - Street 1:460 W 34TH ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2320
Practice Address - Country:US
Practice Address - Phone:212-273-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096394-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker