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General NPI Number Information
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NPI Number | 1699240705
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Entity Type | Individual
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Provider Name | MARY THERESA DOYLE LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 28 CRESCENT ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3650
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Country | US
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Telephone | 860-358-6427
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Fax | 860-358-4457
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Provider Business Mailing Address
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Address Line | 2950 STATE ST UNIT 10
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City | HAMDEN
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State | CT
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Zip | 06517-1715
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Country | US
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Telephone | 321-303-8894
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 009622
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License Number State | CT
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