Provider Demographics
NPI:1194967935
Name:O'BYRNE, COLLEEN SERENA (PSYD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:SERENA
Last Name:O'BYRNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2601
Mailing Address - Country:US
Mailing Address - Phone:202-645-8739
Mailing Address - Fax:202-645-8798
Practice Address - Street 1:2700 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2601
Practice Address - Country:US
Practice Address - Phone:202-645-8739
Practice Address - Fax:202-645-8798
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004057103TC0700X
DCPSY1000541103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical