Healthcare Provider Details

I. General information

NPI: 1891785861
Provider Name (Legal Business Name): MELISSA MARIE DOYLE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA BARTON DR
ALBANY NY
12208-3401
US

IV. Provider business mailing address

1 CLARA BARTON DR
ALBANY NY
12208-3401
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5588
  • Fax: 518-262-6229
Mailing address:
  • Phone: 518-262-5588
  • Fax: 518-262-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number052153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: