Provider Demographics
NPI:1154790400
Name:BYRNE, JONATHAN S (LCSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:BYRNE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CLAREMONT AVE
Mailing Address - Street 2:(OPTIONAL)
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3035
Mailing Address - Country:US
Mailing Address - Phone:201-674-0702
Mailing Address - Fax:
Practice Address - Street 1:294 HARRINGTON AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1912
Practice Address - Country:US
Practice Address - Phone:201-564-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056760001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical