Basic Information
| Provider Information | |||||||||
| NPI: | 1619045226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | CARMELA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | MA,CCC L-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | WURTSBORO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127904906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458884078 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 FLETCHER ST | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109241402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452948806 | ||||||||
| FaxNumber: | 8452948650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 005577-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 10106804 | 01 | NY | CDPHP | OTHER | 87757 | 01 | NY | GHI | OTHER | M18411 | 01 | NY | EMPIREBLUECROSSBLUESHIELD | OTHER |