Provider Demographics
NPI:1699814004
Name:DOYLE, JUDITH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:MUTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:326 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-348-6100
Mailing Address - Fax:570-969-8626
Practice Address - Street 1:326 ADAMS AVE
Practice Address - Street 2:SCRANTON COUNSELING CENTER
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-348-6100
Practice Address - Fax:570-969-8626
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CW001312L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA603511FXNMedicare PIN