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General NPI Number Information
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NPI Number | 1780902478
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Entity Type | Individual
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Provider Name | JUSTIN MICHAEL DOYLE LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 153 HAZARD AVE
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City | ENFIELD
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State | CT
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Zip | 06082-4592
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Country | US
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Telephone | 860-550-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 308 WOODGATE CIR
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City | ENFIELD
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State | CT
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Zip | 06082-5573
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Country | US
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Telephone | 860-394-8532
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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 | 008638
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License Number State | CT
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