Basic Information
| Provider Information | |||||||||
| NPI: | 1295262277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYRNE | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | SABINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 FLORENCE RD | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018513504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787291009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017203575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782631427 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2017 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 2909-MH-B1 | MA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.