Provider Demographics
NPI:1952405565
Name:BYRNE, MARY COLLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:COLLEEN
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 1:37 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2518
Mailing Address - Country:US
Mailing Address - Phone:703-618-1415
Mailing Address - Fax:
Practice Address - Street 1:PSYCHOLOGY CLINIC
Practice Address - Street 2:2114 BIOLOGY-PSYCHOLOGY BUILDING
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:301-405-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03870103T00000X
VA0810003031103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist