Basic Information
Provider Information
NPI: 1003001223
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOY
FirstName: MYCO
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 141 E MAIN ST
Address2:  
City: WATERBURY
State: CT
PostalCode: 067022310
CountryCode: US
TelephoneNumber: 2035749000
FaxNumber: 2035749006
Practice Location
Address1: 141 E MAIN ST
Address2:  
City: WATERBURY
State: CT
PostalCode: 067022310
CountryCode: US
TelephoneNumber: 2035749000
FaxNumber: 2035749006
Other Information
ProviderEnumerationDate: 09/11/2007
LastUpdateDate: 02/17/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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