MEDICARE: MS. CATRICIA LYNN PAYNE MSW, LSW, LCDC-III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.081203	OH
2	104100000X	Social Worker	S.0020442	OH

General Provider Information

NPI Number	:	1447793278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATRICIA LYNN PAYNE MSW, LSW, LCDC-III

Provider Business Mailing Address
First Line	:	45 W MELFORD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1741
Country	:	US
Telephone Number	:	937-241-2099
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 W MELFORD AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1741
Country	:	US
Telephone Number	:	937-241-2099
Fax Number	:

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

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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