Healthcare Provider Details

I. General information

NPI: 1386784528
Provider Name (Legal Business Name): PATRICIA H BYRNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 OCEAN AVE
LYNN MA
01902-3213
US

IV. Provider business mailing address

43 OCEAN AVE
LYNN MA
01902-3213
US

V. Phone/Fax

Practice location:
  • Phone: 617-623-1814
  • Fax:
Mailing address:
  • Phone: 617-623-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110563
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: