Provider Demographics
NPI:1386673242
Name:BYERS, MARK LAMAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAMAR
Last Name:BYERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROCKWOOD TER
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1805
Mailing Address - Country:US
Mailing Address - Phone:617-899-4654
Mailing Address - Fax:
Practice Address - Street 1:2 ARNOLD CIR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2213
Practice Address - Country:US
Practice Address - Phone:617-899-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO1431OtherBLUE CROSS PROVIDER NUMBE