Provider Demographics
NPI:1366442980
Name:MCCOIN, CAROL ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MCCOIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3832
Mailing Address - Country:US
Mailing Address - Phone:508-620-1655
Mailing Address - Fax:508-620-0418
Practice Address - Street 1:40 SPEEN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-1898
Practice Address - Country:US
Practice Address - Phone:508-620-1655
Practice Address - Fax:508-620-0418
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10279811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20874Medicare PIN