Provider Demographics
NPI:1609001379
Name:DOYLE, EUGENE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:DOYLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-4010
Mailing Address - Country:US
Mailing Address - Phone:718-843-2290
Mailing Address - Fax:718-843-2291
Practice Address - Street 1:10212 164TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-4010
Practice Address - Country:US
Practice Address - Phone:718-843-2290
Practice Address - Fax:718-843-2291
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-019169104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01111242Medicaid