Provider Demographics
NPI:1780749390
Name:PAYNE, SLOANE WALLER JR (PHD)
Entity type:Individual
Prefix:DR
First Name:SLOANE
Middle Name:WALLER
Last Name:PAYNE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 HOMESTEAD RD
Mailing Address - Street 2:KAISER ADULT PSYCHIATRY
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0712
Mailing Address - Country:US
Mailing Address - Phone:408-366-4439
Mailing Address - Fax:
Practice Address - Street 1:19000 HOMESTEAD RD
Practice Address - Street 2:KAISER ADULT PSYCHIATRY
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15172103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist