Healthcare Provider Details

I. General information

NPI: 1780764431
Provider Name (Legal Business Name): ARLENE DIANNE PAYNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 SOUTH AVE SUITE #1
GUSTINE CA
95322-1503
US

IV. Provider business mailing address

680 SOUTH AVE SUITE #1
GUSTINE CA
95322-1503
US

V. Phone/Fax

Practice location:
  • Phone: 209-704-0164
  • Fax:
Mailing address:
  • Phone: 209-704-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: