Provider Demographics
NPI:1619482320
Name:BOYLE, DENNIS (LCSW)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BOYLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 DEER PARK AVE STE 6A
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2119
Mailing Address - Country:US
Mailing Address - Phone:718-208-5736
Mailing Address - Fax:
Practice Address - Street 1:2100 DEER PARK AVE STE 6A
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2119
Practice Address - Country:US
Practice Address - Phone:718-208-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0926121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical