Healthcare Provider Details

I. General information

NPI: 1003740473
Provider Name (Legal Business Name): BENJAMIN E PAYNE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 VIRGINIA ST
GRIDLEY CA
95948-2133
US

IV. Provider business mailing address

PO BOX 1446
GRIDLEY CA
95948-1446
US

V. Phone/Fax

Practice location:
  • Phone: 530-846-4955
  • Fax: 530-846-4954
Mailing address:
  • Phone: 530-682-8189
  • Fax: 530-846-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: