Provider Demographics
NPI:1134960859
Name:COYL, SAMUEL DAVID
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID
Last Name:COYL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 WOODED CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:PERKIOMENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18074-9201
Mailing Address - Country:US
Mailing Address - Phone:717-712-2966
Mailing Address - Fax:
Practice Address - Street 1:2294 WOODED CREEK CIR
Practice Address - Street 2:
Practice Address - City:PERKIOMENVILLE
Practice Address - State:PA
Practice Address - Zip Code:18074-9201
Practice Address - Country:US
Practice Address - Phone:717-712-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker