Provider Demographics
NPI:1972863306
Name:PHOENIX-DOYLE, KATHEY (MA)
Entity Type:Individual
Prefix:
First Name:KATHEY
Middle Name:
Last Name:PHOENIX-DOYLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SAN PABLO ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3103
Mailing Address - Country:US
Mailing Address - Phone:505-944-7224
Mailing Address - Fax:505-944-7229
Practice Address - Street 1:209 SAN PABLO ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3103
Practice Address - Country:US
Practice Address - Phone:505-944-7224
Practice Address - Fax:505-944-7229
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33163104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker