Provider Demographics
NPI:1780764431
Name:PAYNE, ARLENE DIANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:DIANNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 SOUTH AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GUSTINE
Mailing Address - State:CA
Mailing Address - Zip Code:95322-1503
Mailing Address - Country:US
Mailing Address - Phone:209-704-0164
Mailing Address - Fax:
Practice Address - Street 1:680 SOUTH AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:GUSTINE
Practice Address - State:CA
Practice Address - Zip Code:95322-1503
Practice Address - Country:US
Practice Address - Phone:209-704-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS144791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ35280ZMedicare ID - Type UnspecifiedPART B