Provider Demographics
NPI:1669627485
Name:BOYLE, DEIRDRE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W 110TH ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2106
Mailing Address - Country:US
Mailing Address - Phone:212-666-2202
Mailing Address - Fax:
Practice Address - Street 1:610 W 110TH ST APT 7B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2106
Practice Address - Country:US
Practice Address - Phone:212-666-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker