Provider Demographics
NPI:1720766504
Name:PAYNE, MELANIE (ACSW, MSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ACSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 S MAIN ST # 328
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-2013
Mailing Address - Country:US
Mailing Address - Phone:832-876-4211
Mailing Address - Fax:
Practice Address - Street 1:752 S MAIN ST # 328
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2013
Practice Address - Country:US
Practice Address - Phone:832-876-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical