Provider Demographics
NPI:1841369873
Name:DOYLE, ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MILL RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05352-9638
Mailing Address - Country:US
Mailing Address - Phone:413-458-0300
Mailing Address - Fax:413-458-0300
Practice Address - Street 1:90 ADAMS ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-9399
Practice Address - Fax:413-458-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6824103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05796OtherBC/BS OF MA PROVIDER #
MA374570OtherMVP PROVIDER #
MA0526967OtherMASS HEALTH PROVIDER #
MA460550OtherTUFTS PROVIDER #
MADOW5048Medicare ID - Type UnspecifiedPROVIDER NUMBER