Provider Demographics
NPI:1538283916
Name:COYLE, STACY (PSYD, LP)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 JENIFER ST NW
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2113
Mailing Address - Country:US
Mailing Address - Phone:202-642-2214
Mailing Address - Fax:202-244-8065
Practice Address - Street 1:4400 JENIFER ST NW
Practice Address - Street 2:SUITE 280
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2113
Practice Address - Country:US
Practice Address - Phone:202-642-2214
Practice Address - Fax:202-244-8065
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4927103TC0700X
DC1000739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical