Provider Demographics
NPI:1154435352
Name:BYRNE, SARAH CATHERINE (EDS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CATHERINE
Last Name:BYRNE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6472
Mailing Address - Country:US
Mailing Address - Phone:602-681-9121
Mailing Address - Fax:
Practice Address - Street 1:16750 W GARFIELD ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6287
Practice Address - Country:US
Practice Address - Phone:623-772-4724
Practice Address - Fax:623-772-4720
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ879033Medicare UPIN