Provider Demographics
NPI:1902190408
Name:MALLETTE, ELIZABETH PAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAYNE
Last Name:MALLETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:PAYNE
Other - Last Name:EAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1711 PARRISH PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3482
Mailing Address - Country:US
Mailing Address - Phone:270-691-0501
Mailing Address - Fax:270-691-0510
Practice Address - Street 1:1711 PARRISH PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3482
Practice Address - Country:US
Practice Address - Phone:270-691-0501
Practice Address - Fax:270-691-0510
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100295000Medicaid
KY7100296110Medicaid