Provider Demographics
NPI:1235420647
Name:DOYLE, ANDREA (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 CHANCELLOR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4109
Mailing Address - Country:US
Mailing Address - Phone:215-746-5486
Mailing Address - Fax:
Practice Address - Street 1:3701 LOCUST WALK
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6214
Practice Address - Country:US
Practice Address - Phone:215-746-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0169261041C0700X
NJ44SC054578001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW016926OtherPA STATE BOARD OF SOCIAL WORKERS, MARITAL AND FAMILY THERAPISTS, AND PROFESSIONA