Provider Demographics
NPI:1013446848
Name:MCCOY, SEAN (BCABA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:BCABA
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:813-957-8327
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:813-957-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-10-3910103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020353500Medicaid