Provider Demographics
NPI:1689126450
Name:DOYLE, SARAH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:KEENE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12943-0669
Mailing Address - Country:US
Mailing Address - Phone:518-637-1358
Mailing Address - Fax:518-412-3553
Practice Address - Street 1:44 MARKET ST # 669
Practice Address - Street 2:
Practice Address - City:KEENE VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12943-7700
Practice Address - Country:US
Practice Address - Phone:518-637-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657453163W00000X
CANP95020879163W00000X, 363LP0808X
NM60670163W00000X
NYF403003-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061339621Medicaid