Healthcare Provider Details

I. General information

NPI: 1972329415
Provider Name (Legal Business Name): LATONIA PAYNE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 EASTERN PKWY STE 3328
LOUISVILLE KY
40217-1415
US

IV. Provider business mailing address

4906 CELESTE DR
LOUISVILLE KY
40228-1287
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone: 502-716-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number254122
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: