Healthcare Provider Details

I. General information

NPI: 1831970466
Provider Name (Legal Business Name): JEANNETTE UWINEZA-MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13-15 E DEER PARK DR #103D
GAITHERSBURG MD
20877
US

IV. Provider business mailing address

30 BEAUVOIR CT
ROCKVILLE MD
20855-1250
US

V. Phone/Fax

Practice location:
  • Phone: 24-075-0884
  • Fax:
Mailing address:
  • Phone: 301-502-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberA0759
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberA0759
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberA0759
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberA0759
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberA0759
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberA0759
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberA0759
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: