Provider Demographics
NPI:1275288847
Name:BYRNE, BRIAN MATTHEW (BCBA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MATTHEW
Last Name:BYRNE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:M
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:8170 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6434
Mailing Address - Country:US
Mailing Address - Phone:855-400-3455
Mailing Address - Fax:
Practice Address - Street 1:8170 SOUTH AVE STE 7
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6434
Practice Address - Country:US
Practice Address - Phone:855-400-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst