Provider Demographics
NPI:1811017403
Name:COYLE, VIRGINIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 LONG BEACH BLVD STE 4065
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3315
Mailing Address - Country:US
Mailing Address - Phone:562-685-3016
Mailing Address - Fax:562-318-3081
Practice Address - Street 1:3711 LONG BEACH BLVD STE 4065
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3315
Practice Address - Country:US
Practice Address - Phone:562-685-3016
Practice Address - Fax:562-318-3081
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27169103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist