Provider Demographics
NPI:1285959270
Name:BOYLE, MICHAEL P (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:BOYLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SCUDDER CT
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2325
Mailing Address - Country:US
Mailing Address - Phone:609-731-3861
Mailing Address - Fax:
Practice Address - Street 1:2999 PRINCETON PIKE
Practice Address - Street 2:SUITE #5
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3261
Practice Address - Country:US
Practice Address - Phone:609-731-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S00319900103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral