Provider Demographics
NPI:1104913128
Name:KYLE, DORIS A (MSW)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:A
Last Name:KYLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAIN ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1518
Mailing Address - Country:US
Mailing Address - Phone:570-723-1005
Mailing Address - Fax:570-723-1006
Practice Address - Street 1:107 MAIN ST UNIT 3
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1518
Practice Address - Country:US
Practice Address - Phone:570-723-1005
Practice Address - Fax:570-723-1006
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1727101YA0400X
PACW000402L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)