Provider Demographics
NPI:1891785861
Name:DOYLE, MELISSA MARIE (CSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CLARA BARTON DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3401
Mailing Address - Country:US
Mailing Address - Phone:518-262-5588
Mailing Address - Fax:518-262-6229
Practice Address - Street 1:1 CLARA BARTON DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3401
Practice Address - Country:US
Practice Address - Phone:518-262-5588
Practice Address - Fax:518-262-6229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052153104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01917766Medicaid
NYS66553Medicare UPIN