Provider Demographics
NPI:1023141009
Name:PAYNE, KATHLEEN MCGUNNIGLE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MCGUNNIGLE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8040 CORPORATE CIR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1282
Mailing Address - Country:US
Mailing Address - Phone:440-476-8027
Mailing Address - Fax:440-345-3456
Practice Address - Street 1:8040 CORPORATE CIR
Practice Address - Street 2:SUITE #4
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1282
Practice Address - Country:US
Practice Address - Phone:440-476-8027
Practice Address - Fax:440-345-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6106103TC0700X
NY015165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical