Basic Information
| Provider Information | |||||||||
| NPI: | 1376054973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COYLE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32 | ||||||||
| Address2: | |||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189600032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674045734 | ||||||||
| FaxNumber: | 2152574008 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152576551 | ||||||||
| FaxNumber: | 2152579347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2017 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW020780 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.