Provider Demographics
NPI:1114324407
Name:PAYNE, CAROLINE PIERPONT (PSYD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PIERPONT
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:PIERPONT
Other - Last Name:KOTONIAS-PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2169 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-437-6550
Mailing Address - Fax:518-437-6565
Practice Address - Street 1:42 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:585-919-0018
Practice Address - Fax:585-393-0014
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018865103T00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent