Provider Demographics
NPI:1750614533
Name:COY, DENNIS MICHAEL (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:COY
Suffix:
Gender:M
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:D. MICHAEL
Other - Middle Name:
Other - Last Name:COY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LICSW
Mailing Address - Street 1:1216 BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1224
Mailing Address - Country:US
Mailing Address - Phone:773-729-0383
Mailing Address - Fax:
Practice Address - Street 1:423 PACIFIC AVE STE 302
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1940
Practice Address - Country:US
Practice Address - Phone:773-729-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605344981041C0700X
IL1490134251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2853Medicare UPIN