Healthcare Provider Details

I. General information

NPI: 1285203182
Provider Name (Legal Business Name): MAIA C MCCOY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11208 PARKHILL PL NE
BAINBRIDGE ISLAND WA
98110-1323
US

IV. Provider business mailing address

10355 NE VALLEY RD UNIT 4466
ROLLINGBAY WA
98061-0019
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-1371
  • Fax:
Mailing address:
  • Phone: 401-349-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61516648
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: