Provider Demographics
NPI:1629307905
Name:KOYL, MARY E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:KOYL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179TH ST AND LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11425
Mailing Address - Country:US
Mailing Address - Phone:718-526-1000
Mailing Address - Fax:718-298-8515
Practice Address - Street 1:179TH ST AND LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11425
Practice Address - Country:US
Practice Address - Phone:718-526-1000
Practice Address - Fax:718-298-8515
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO21148-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker