Provider Demographics
NPI:1780724377
Name:BYRNE, MARY P (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:P
Last Name:BYRNE
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 LINNAEAN ST
Mailing Address - Street 2:APT 45
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1542
Mailing Address - Country:US
Mailing Address - Phone:617-868-6866
Mailing Address - Fax:978-542-6396
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:SHULMAN SUITE
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6535
Practice Address - Country:US
Practice Address - Phone:617-576-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO2671OtherBLUE CROSSAND BLUE SHIELD