Healthcare Provider Details

I. General information

NPI: 1346773637
Provider Name (Legal Business Name): KATE PAYNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BROADWAY
OAKLAND CA
94611-5714
US

IV. Provider business mailing address

3505 BROADWAY FL 14
OAKLAND CA
94611-5714
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-5711
  • Fax:
Mailing address:
  • Phone: 510-752-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: