Provider Demographics
NPI:1417535675
Name:LYLE, LATOYA TERRINE
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:TERRINE
Last Name:LYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LATOYA
Other - Middle Name:TERRINE
Other - Last Name:LYLE-KIRLEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:320 GREENGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1519
Mailing Address - Country:US
Mailing Address - Phone:203-559-1885
Mailing Address - Fax:516-565-0536
Practice Address - Street 1:200 N VILLAGE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2300
Practice Address - Country:US
Practice Address - Phone:203-559-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist