Provider Demographics
NPI:1467553354
Name:COYLE, MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROGER ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4624
Mailing Address - Country:US
Mailing Address - Phone:516-782-2439
Mailing Address - Fax:
Practice Address - Street 1:2146 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2606
Practice Address - Country:US
Practice Address - Phone:516-221-3030
Practice Address - Fax:516-221-4160
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068720-11041C0700X
NY083398-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical