1326412396 NPI number — MRS. CHICQUITA LAQUANDA MCCOVERY LMSW

Table of content: MRS. CHICQUITA LAQUANDA MCCOVERY LMSW (NPI 1326412396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326412396 NPI number — MRS. CHICQUITA LAQUANDA MCCOVERY LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOVERY
Provider First Name:
CHICQUITA
Provider Middle Name:
LAQUANDA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCOVERY-MEDINA
Provider Other First Name:
CHICQUITA
Provider Other Middle Name:
LAQUANDA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326412396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 TRANTOR PL APT 1B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10302-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-541-2046
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 W 34TH ST
Provider Second Line Business Practice Location Address:
11TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-2320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-273-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  096394-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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