Healthcare Provider Details

I. General information

NPI: 1659604460
Provider Name (Legal Business Name): ELIZABETH PAYNE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABET TOOHER

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HAYNES RD
PLAINVILLE MA
02762-1709
US

IV. Provider business mailing address

5 HAYNES RD
PLAINVILLE MA
02762-1709
US

V. Phone/Fax

Practice location:
  • Phone: 617-899-2797
  • Fax:
Mailing address:
  • Phone: 617-899-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number979868
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116742
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: