Healthcare Provider Details

I. General information

NPI: 1285446211
Provider Name (Legal Business Name): MARIA CHEYENNE MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA CHEYENNE MCCOY-JUSTINIANO

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 INDIANOLA AVE
COLUMBUS OH
43201-2118
US

IV. Provider business mailing address

352 E 13TH AVE
COLUMBUS OH
43201-4910
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-2661
  • Fax:
Mailing address:
  • Phone: 614-496-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2504084-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: