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General NPI Number Information
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NPI Number | 1871044834
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Entity Type | Individual
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Provider Name | MEGAN FREDRICKS COCCO LCSWC
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Gender | Female
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1600 CRAIN HWY S SUITE 503
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5577
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Country | US
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Telephone | 443-354-1200
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Fax | 410-553-0019
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Provider Business Mailing Address
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Address Line | 1600 CRAIN HWY S SUITE 503
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5577
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Country | US
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Telephone | 443-354-1200
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Fax | 410-553-0019
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19279
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License Number State | MD
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