Provider Demographics
NPI:1518046192
Name:COYLE, JOHN B (LMFT CASAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:COYLE
Suffix:
Gender:M
Credentials:LMFT CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 N. BROADWAY (RT. 9)
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571
Mailing Address - Country:US
Mailing Address - Phone:845-206-8815
Mailing Address - Fax:845-758-0608
Practice Address - Street 1:7509 N. BROADWAY (RT. 9)
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571
Practice Address - Country:US
Practice Address - Phone:845-206-8815
Practice Address - Fax:845-758-0608
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCREDENTIAL # 3356101YA0400X
NY000483106H00000X
NY000483-1106H00000X
NY3356101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000483OtherLMFT
NY3356OtherCASAC