Provider Demographics
NPI:1962465906
Name:MCCOY, RAYMOND D (PSYD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:D
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 HILLINGDON CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6455
Mailing Address - Country:US
Mailing Address - Phone:757-761-6894
Mailing Address - Fax:866-399-5471
Practice Address - Street 1:712 HILLINGDON CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6455
Practice Address - Country:US
Practice Address - Phone:757-761-6894
Practice Address - Fax:866-399-5471
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040011361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008912564Medicaid
VA249249OtherMAMSI
VA324388OtherANTHEM BLUE CROSS
VA800002227Medicare ID - Type Unspecified