Provider Demographics
NPI:1437328234
Name:PAYNE, LORA L (MED LADC1)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:L
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MED LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ANDREW ST
Mailing Address - Street 2:2A
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4064
Mailing Address - Country:US
Mailing Address - Phone:978-317-3271
Mailing Address - Fax:978-921-0044
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 323 G
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-317-3271
Practice Address - Fax:978-921-0044
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA329101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)