Doctor Name: | MS. MELISSA COYLE |
NPI Number: | 1528190212 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW-R |
License Number: | 073624 |
Business Practice Address: | 107 Pond Path Lake Grove, NY - 11755 |
Business Phone Number: | 6319888656 |
Business Fax Number: | |
Mailing Address: | 107 Pond Path, LAKE GROVE |
State: | NY |
Postal Code: | 11755 |
Phone Number: | 6319888656 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2007 |
NPI Last Update Date: | 12/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 073624 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |