Healthcare Provider Details

I. General information

NPI: 1033549324
Provider Name (Legal Business Name): RICHARD J. BYRNE JR. LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD BLD 143CW
LYONS NJ
07939-5001
US

IV. Provider business mailing address

151 KNOLLCROFT RD BLD. 143 CW
LYONS NJ
07939-5001
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5836
Mailing address:
  • Phone: 908-647-0180
  • Fax: 908-604-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05816600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: