MEDICARE: NATASHA MCKOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1568830941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA MCKOY

Provider Business Mailing Address
First Line	:	600 N OLIVE ST
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-2418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 N GLENWOOD AVE
Second Line	:
City	:	CLIFTON HEIGHTS
State	:	PA
Zip	:	19018-1609
Country	:	US
Telephone Number	:	616-626-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/11/2015

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Directions to “ NATASHA MCKOY ” Practice Location

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