Provider Demographics
NPI:1235677485
Name:DOYLE, RYAN
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:DOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16121 JAMAICA AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6113
Mailing Address - Country:US
Mailing Address - Phone:718-896-2500
Mailing Address - Fax:
Practice Address - Street 1:8931 161ST ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6140
Practice Address - Country:US
Practice Address - Phone:718-896-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087832-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical