Provider Demographics
NPI:1619341013
Name:COYLE, MICHELLE S (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:COYLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WAGNER PL
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1861
Mailing Address - Country:US
Mailing Address - Phone:973-399-3132
Mailing Address - Fax:973-399-7552
Practice Address - Street 1:21 WAGNER PL
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1861
Practice Address - Country:US
Practice Address - Phone:973-399-3132
Practice Address - Fax:973-399-7552
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06091700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker