Healthcare Provider Details

I. General information

NPI: 1538522248
Provider Name (Legal Business Name): THOMAS DOYLE MS,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 COUNTY ROUTE 14
RENSSELAER FALLS NY
13680-3104
US

IV. Provider business mailing address

1201 COUNTY ROUTE 14
RENSSELAER FALLS NY
13680-3104
US

V. Phone/Fax

Practice location:
  • Phone: 315-344-7358
  • Fax:
Mailing address:
  • Phone: 315-344-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003753-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: