Provider Demographics
NPI:1629375530
Name:DEGRAW, DOYLE NORMAN (LIMITED LMHC)
Entity Type:Individual
Prefix:
First Name:DOYLE
Middle Name:NORMAN
Last Name:DEGRAW
Suffix:
Gender:M
Credentials:LIMITED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PEMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2636
Mailing Address - Country:US
Mailing Address - Phone:616-633-3565
Mailing Address - Fax:
Practice Address - Street 1:58 PEMBROOK DR
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2636
Practice Address - Country:US
Practice Address - Phone:616-633-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008236101YM0800X
NYP96322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health