Provider Demographics
NPI:1952628059
Name:DEBORAH L. MCCOY BEHAVIOR ANALYST INC.
Entity Type:Organization
Organization Name:DEBORAH L. MCCOY BEHAVIOR ANALYST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:813-957-8327
Mailing Address - Street 1:2860 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4631
Mailing Address - Country:US
Mailing Address - Phone:813-957-8327
Mailing Address - Fax:866-471-0650
Practice Address - Street 1:2860 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4631
Practice Address - Country:US
Practice Address - Phone:813-957-8327
Practice Address - Fax:866-471-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0560103K00000X
FL0-08-2523103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01851200Medicaid
FL676938196OtherMEDICAID WAIVER