Provider Demographics
NPI:1477681278
Name:COYLE, BRENDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PHEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3041
Mailing Address - Country:US
Mailing Address - Phone:860-335-5844
Mailing Address - Fax:
Practice Address - Street 1:50 ALBANY TPKE
Practice Address - Street 2:SUITE 5023
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2516
Practice Address - Country:US
Practice Address - Phone:860-335-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002258CT02OtherANTHEM BCBS