Provider Demographics
NPI:1871044834
Name:COCCO, MEGAN FREDRICKS (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:FREDRICKS
Last Name:COCCO
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CRAIN HWY S
Mailing Address - Street 2:SUITE 503
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5577
Mailing Address - Country:US
Mailing Address - Phone:443-354-1200
Mailing Address - Fax:410-553-0019
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 503
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:443-354-1200
Practice Address - Fax:410-553-0019
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health