Provider Demographics
NPI:1366704942
Name:BYRNE, KELLY E (MSED, SDA, BCBA,LBA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:E
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MSED, SDA, BCBA,LBA
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:E
Other - Last Name:ORLANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 HOLMES PL
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1142
Mailing Address - Country:US
Mailing Address - Phone:516-946-3008
Mailing Address - Fax:
Practice Address - Street 1:45 HOLMES PL
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1142
Practice Address - Country:US
Practice Address - Phone:516-946-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
NY001121-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No252Y00000XAgenciesEarly Intervention Provider Agency