Provider Demographics
NPI:1558616235
Name:MCCOY, IRENE E (MS CCC SP)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:E
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MS CCC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CATHEDRAL AVE
Mailing Address - Street 2:PUPIL PERSONNEL SERVICES
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2819
Mailing Address - Country:US
Mailing Address - Phone:516-478-1050
Mailing Address - Fax:516-294-5009
Practice Address - Street 1:56 CATHEDRAL AVE
Practice Address - Street 2:PUPIL PERSONNEL SERVICES
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2819
Practice Address - Country:US
Practice Address - Phone:516-478-1050
Practice Address - Fax:516-294-5009
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00003753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist