Provider Demographics
NPI:1124300470
Name:BYRNE, JOSEPH W (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:BYRNE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 W FRONTAGE RD STE 232
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3034
Mailing Address - Country:US
Mailing Address - Phone:847-644-1210
Mailing Address - Fax:
Practice Address - Street 1:456 W FRONTAGE RD STE 232
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3034
Practice Address - Country:US
Practice Address - Phone:847-644-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical