Provider Demographics
NPI:1639822562
Name:BYRD, CARL EDWIN (MA)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:EDWIN
Last Name:BYRD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6154 AUTUMN PINES CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6368
Mailing Address - Country:US
Mailing Address - Phone:301-646-3357
Mailing Address - Fax:
Practice Address - Street 1:5642 JONES ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-2304
Practice Address - Country:US
Practice Address - Phone:850-626-7779
Practice Address - Fax:850-626-7171
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty