Provider Demographics
NPI:1194835355
Name:BYRNE, DAVID A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BYRNE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094
Mailing Address - Country:US
Mailing Address - Phone:920-261-4100
Mailing Address - Fax:920-261-8801
Practice Address - Street 1:1315 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094
Practice Address - Country:US
Practice Address - Phone:920-261-4100
Practice Address - Fax:920-261-8801
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2193057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13698OtherDION HEALTH INS
WI39184249618OtherUNITY INSURANCE LAKE MILL
WI214888OtherMHN INSURANCE
WI39184249617OtherUNITY INSURANCE WATERTOWN
39184249610OtherJOHN DEERE HEALTH
WI2002997OtherPHYSICIANS PLUS INS
6156673OtherUNITED BEHAVIORAL HEALTH
WI39184249618OtherUNITY INSURANCE LAKE MILL