Provider Demographics
NPI:1164737870
Name:PAYNE, SUSAN EVELYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:EVELYN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 50TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3934
Mailing Address - Country:US
Mailing Address - Phone:941-755-0498
Mailing Address - Fax:941-755-0534
Practice Address - Street 1:3311 50TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3934
Practice Address - Country:US
Practice Address - Phone:941-755-0498
Practice Address - Fax:941-755-0534
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW61411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical