Provider Demographics
NPI:1144378845
Name:DOEHLER, CARYN LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:LYNN
Last Name:DOEHLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-7401
Mailing Address - Country:US
Mailing Address - Phone:248-982-1029
Mailing Address - Fax:248-380-1830
Practice Address - Street 1:332 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-7401
Practice Address - Country:US
Practice Address - Phone:248-982-1029
Practice Address - Fax:248-380-1830
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010734951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0895606OtherBLUECROSSBLUE SHIELDOFMI
MI0N99280Medicare ID - Type Unspecified