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General NPI Number Information
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NPI Number | 1477681278
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Entity Type | Individual
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Provider Name | BRENDA COYLE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 ALBANY TPKE SUITE 5023
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City | CANTON
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State | CT
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Zip | 06019-2516
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Country | US
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Telephone | 860-335-5844
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Fax |
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Provider Business Mailing Address
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Address Line | 32 PHEASANT HILL RD
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City | COLLINSVILLE
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State | CT
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Zip | 06019-3041
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Country | US
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Telephone | 860-335-5844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002258
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License Number State | CT
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