Provider Demographics
NPI:1467731604
Name:MCCOY, DEBORAH LEE (BCBA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7663 CR 247
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538-3047
Mailing Address - Country:US
Mailing Address - Phone:352-330-0844
Mailing Address - Fax:
Practice Address - Street 1:7663 CR 247
Practice Address - Street 2:
Practice Address - City:LAKE PANASOFFKEE
Practice Address - State:FL
Practice Address - Zip Code:33538-3047
Practice Address - Country:US
Practice Address - Phone:352-330-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0560103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
676938196OtherMEDICAID WAIVER
676938198OtherMEDICAID WAIVER