Provider Demographics
NPI:1821120346
Name:BYRNE, MARY DORES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:DORES
Last Name:BYRNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1944
Mailing Address - Country:US
Mailing Address - Phone:914-779-2401
Mailing Address - Fax:
Practice Address - Street 1:479 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-5516
Practice Address - Country:US
Practice Address - Phone:914-793-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007728-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV71713Medicare ID - Type Unspecified