Provider Demographics
NPI:1558651372
Name:PAYNE, VAJEZATHA ZACCAI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VAJEZATHA
Middle Name:ZACCAI
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2220 E PALMDALE BLVD
Mailing Address - Street 2:STE. 901588
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-6500
Mailing Address - Country:US
Mailing Address - Phone:310-200-6573
Mailing Address - Fax:
Practice Address - Street 1:38345 30TH ST E
Practice Address - Street 2:STE E5
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4984
Practice Address - Country:US
Practice Address - Phone:310-200-6573
Practice Address - Fax:623-399-1501
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS259911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical