Basic Information
| Provider Information | |||||||||
| NPI: | 1316264104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | ERYN | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHUMWAY | ||||||||
| OtherFirstName: | ERYN | ||||||||
| OtherMiddleName: | MARY | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 320 SOUTH BROADWAY | ||||||||
| Address2: | UNIT R6 | ||||||||
| City: | TARRYTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149497699 | ||||||||
| FaxNumber: | 9149493224 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 NO. CENTRAL AVENUE | ||||||||
| Address2: | C/O WJCS | ||||||||
| City: | HARTSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149497699 | ||||||||
| FaxNumber: | 9149493224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2010 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 081171 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.