MEDICARE: ASIA NICOLE PAYNE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	66714	CA

General Provider Information

NPI Number	:	1891127601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASIA NICOLE PAYNE LCSW

Provider Business Mailing Address
First Line	:	6187 ATLANTIC AVE # 7008
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-2922
Country	:	US
Telephone Number	:	562-542-7205
Fax Number	:

Provider Business Practice Location Address
First Line	:	6187 ATLANTIC AVE # 7008
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-2922
Country	:	US
Telephone Number	:	562-542-7205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	02/23/2023

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Directions to “ ASIA NICOLE PAYNE LCSW” Practice Location

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