Provider Demographics
NPI:1801938089
Name:COYLE, JEFFREY BRIAN (LCSWR)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:COYLE
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:72 SOUTHSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:718-339-5300
Mailing Address - Fax:718-339-9082
Practice Address - Street 1:333 AVENUE X
Practice Address - Street 2:JEWISH BOARD OF FAMILY AND CHILDREN'S SERVICES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5947
Practice Address - Country:US
Practice Address - Phone:718-339-5300
Practice Address - Fax:718-339-9082
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0463541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1454RKMedicaid