| Doctor Name: | SUSAN MARY BYRNE |
| NPI Number: | 1194965897 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NPP |
| License Number: | F401116-1 |
| Business Practice Address: | 2780 Middle Country Road Suite 306 The Child And Family Wellness Center Lake Grove, NY - 11755 |
| Business Phone Number: | 6319818300 |
| Business Fax Number: | 6319818400 |
| Mailing Address: | 2780 Middle Country Road Suite 306, The Child And Family Wellness Center LAKE GROVE |
| State: | NY |
| Postal Code: | 11755 |
| Phone Number: | 6319818300 |
| Fax Number: | 6319818400 |
| NPI Enumeration Date: | 02/20/2009 |
| NPI Last Update Date: | 06/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | F401116-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |