Provider Demographics
NPI:1396162541
Name:DOYLE, KADERRAH
Entity type:Individual
Prefix:
First Name:KADERRAH
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ASCH LOOP
Mailing Address - Street 2:APT 23D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 ASCH LOOP
Practice Address - Street 2:APT 23D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4010
Practice Address - Country:US
Practice Address - Phone:917-213-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst