Healthcare Provider Details

I. General information

NPI: 1114115490
Provider Name (Legal Business Name): COLLEEN BYRNES M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 TEMPLE ST
WEST ROXBURY MA
02132-3855
US

IV. Provider business mailing address

83 TEMPLE ST
WEST ROXBURY MA
02132-3855
US

V. Phone/Fax

Practice location:
  • Phone: 617-325-8050
  • Fax:
Mailing address:
  • Phone: 617-325-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1018
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1017475
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: