Provider Demographics
NPI:1174806889
Name:BYRNE ZINKEL, MARY CATHERINE (LICSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BYRNE ZINKEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:2265 COMO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1737
Mailing Address - Country:US
Mailing Address - Phone:651-645-5323
Mailing Address - Fax:651-647-5135
Practice Address - Street 1:2265 COMO AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1737
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:651-647-5135
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN194541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical