Provider Demographics
NPI:1477830032
Name:PAYNE, DIANA LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LISA
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 1:11075 SANTA MONICA BLVD
Mailing Address - Street 2:ISAP, SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3556
Mailing Address - Country:US
Mailing Address - Phone:310-267-5236
Mailing Address - Fax:
Practice Address - Street 1:16530 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4554
Practice Address - Country:US
Practice Address - Phone:818-385-0684
Practice Address - Fax:818-385-1166
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist