Provider Demographics
NPI:1508006792
Name:MAYER, CAROLINE PAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PAYNE
Last Name:MAYER
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 1:1377 W SHAW AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3604
Mailing Address - Country:US
Mailing Address - Phone:559-225-3222
Mailing Address - Fax:559-225-3305
Practice Address - Street 1:1377 W SHAW AVE STE 111
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3604
Practice Address - Country:US
Practice Address - Phone:559-225-3222
Practice Address - Fax:559-225-3305
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical