Provider Demographics
NPI:1669228086
Name:BYRNE, MELISSA RAY (LCSWC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAY
Last Name:BYRNE
Suffix:
Gender:
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 SMITH AVE BLDG 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3652
Mailing Address - Country:US
Mailing Address - Phone:919-244-0491
Mailing Address - Fax:
Practice Address - Street 1:1223 MOUNT PLEASANT DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5237
Practice Address - Country:US
Practice Address - Phone:919-244-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000036311041C0700X
MD236511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical