Healthcare Provider Details

I. General information

NPI: 1952405565
Provider Name (Legal Business Name): MARY COLLEEN BYRNE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 KENNEDY ST
ALEXANDRIA VA
22305-2518
US

IV. Provider business mailing address

37 KENNEDY ST
ALEXANDRIA VA
22305-2518
US

V. Phone/Fax

Practice location:
  • Phone: 703-618-1415
  • Fax:
Mailing address:
  • Phone: 703-618-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03870
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: