Provider Demographics
NPI:1245732080
Name:COYLE, TERENCE PATRICK (LMSW)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:PATRICK
Last Name:COYLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1907
Mailing Address - Country:US
Mailing Address - Phone:631-943-2086
Mailing Address - Fax:
Practice Address - Street 1:22 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4231
Practice Address - Country:US
Practice Address - Phone:631-223-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY89049-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical