Provider Demographics
NPI:1770674145
Name:PAYNE, DARYL EUGENE (MSW/LCSW)
Entity type:Individual
Prefix:MR
First Name:DARYL
Middle Name:EUGENE
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-3559
Mailing Address - Country:US
Mailing Address - Phone:860-594-6351
Mailing Address - Fax:860-667-6747
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-594-6351
Practice Address - Fax:860-667-6842
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CT008375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)