Provider Demographics
NPI:1073621389
Name:PAYNE, JANE W (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:W
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3872 E HARBOR LIGHT LANDING DR
Mailing Address - Street 2:200
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3877
Mailing Address - Country:US
Mailing Address - Phone:419-734-3333
Mailing Address - Fax:877-734-2030
Practice Address - Street 1:5001 MAYFIELD RD
Practice Address - Street 2:200
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2602
Practice Address - Country:US
Practice Address - Phone:216-291-4000
Practice Address - Fax:216-291-4111
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH4367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH620003450OtherRAILROAD MEDICARE
OH6100372OtherEVERCARE
OH042501002OtherMAGELLAN
OH000000137848OtherANTHEM
OH0182387Medicaid
OH84523OtherQUALCHOICE
OHCP08511Medicare ID - Type Unspecified