Healthcare Provider Details

I. General information

NPI: 1891785861
Provider Name (Legal Business Name): MELISSA MARIE DOYLE PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BROAD ST STE 606
NEWARK NJ
07102-3112
US

IV. Provider business mailing address

500 BROAD ST
NEWARK NJ
07102-3112
US

V. Phone/Fax

Practice location:
  • Phone: 201-347-1641
  • Fax:
Mailing address:
  • Phone: 201-347-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06460900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017060
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number052153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: