MEDICARE: MRS. GENEVIEVE ROSE PAYNE MFT

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	106H00000X	Marriage & Family Therapist	81820	CA

General Provider Information

NPI Number	:	1144501776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GENEVIEVE ROSE PAYNE MFT

Provider Business Mailing Address
First Line	:	1715 SOLANO AVE
Second Line	:	SUITE B
City	:	BERKELEY
State	:	CA
Zip	:	94707-2220
Country	:	US
Telephone Number	:	510-984-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 SOLANO AVE
Second Line	:	SUITE B
City	:	BERKELEY
State	:	CA
Zip	:	94707-2220
Country	:	US
Telephone Number	:	510-984-6211
Fax Number	:

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	06/13/2015

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