Active NPI
Kenneth Lamar McCoy, LLMSW
- Social Worker
- Grand Rapids, MI
National Provider Identifier
1528218864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801085178/2172616
- Practice address
- 40 Jefferson Ave SE
Grand Rapids, MI 49503-4304 - Phone
- (616) 456-1443
- Fax
- (616) 732-6392
- NPI assigned
- Sep 23, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801085178/2172616 | MI | Primary |
Addresses
Primary practice location
40 Jefferson Ave SE
Grand Rapids, MI 49503-4304
Mailing address
4711 Walma Ave SE
204
Kentwood, MI 49512-5250
Phone (616) 819-0295
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801085178/2172616 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222128000000",
"number": "1528218864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4711 WALMA AVE SE",
"address_2": "204",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495125250",
"telephone_number": "616-819-0295",
"fax_number": "616-656-0193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 JEFFERSON AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034304",
"telephone_number": "616-456-1443",
"fax_number": "616-732-6392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOY",
"first_name": "KENNETH",
"middle_name": "LAMAR",
"name_prefix": "Mr.",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-23",
"last_updated": "2008-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801085178/2172616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.