MEDICARE: DR. KATHLEEN MCGUNNIGLE PAYNE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6106	OH
2	103TC0700X	Clinical Psychologist	015165	NY

General Provider Information

NPI Number	:	1023141009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MCGUNNIGLE PAYNE PH.D.

Provider Business Mailing Address
First Line	:	8040 CORPORATE CIR
Second Line	:	SUITE #4
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-1282
Country	:	US
Telephone Number	:	440-476-8027
Fax Number	:	440-345-3456

Provider Business Practice Location Address
First Line	:	8040 CORPORATE CIR
Second Line	:	SUITE #4
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-1282
Country	:	US
Telephone Number	:	440-476-8027
Fax Number	:	440-345-3456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/09/2013

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