Provider Demographics
NPI:1407304744
Name:MCCOY, BRENDA J (LCSW-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8526 WATER OAK RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3730
Mailing Address - Country:US
Mailing Address - Phone:443-854-7459
Mailing Address - Fax:
Practice Address - Street 1:1100 WICOMICO ST STE 509
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2063
Practice Address - Country:US
Practice Address - Phone:443-854-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD221981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical