Basic Information
| Provider Information | |||||||||
| NPI: | 1518040096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | MICHEALE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117067306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316657863 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 OAK ST | ||||||||
| Address2: | |||||||||
| City: | COPIAGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117263111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316917080 | ||||||||
| FaxNumber: | 6316913387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0729091 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.