Provider Demographics
NPI:1629613831
Name:PAYNE, EBONI A
Entity Type:Individual
Prefix:MRS
First Name:EBONI
Middle Name:A
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHATHAM PL
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1919
Mailing Address - Country:US
Mailing Address - Phone:860-754-4897
Mailing Address - Fax:
Practice Address - Street 1:5 CHATHAM PL
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1919
Practice Address - Country:US
Practice Address - Phone:860-754-4897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor