MEDICARE: SHANNON MICHELLE PAYNE PHD, MSW, LCSW

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	1041C0700X	Clinical Social Worker	0904017769	VA

General Provider Information

NPI Number	:	1629885397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MICHELLE PAYNE PHD, MSW, LCSW

Provider Business Mailing Address
First Line	:	11 N CENTRAL AVE
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-4212
Country	:	US
Telephone Number	:	540-416-2302
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 N CENTRAL AVE STE 16
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-4212
Country	:	US
Telephone Number	:	540-416-2302
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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