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NPI Code Detail

MEDICARE: MS. TINA L PAYNE LMSW

MEDICARE: MS. TINA L PAYNE LMSW
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
1104100000XSocial Worker079901-1NY

General Provider Information

NPI Number : 1669789699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TINA L PAYNE LMSW
Provider Business Mailing Address
First Line : 145 W 15TH ST
Second Line : 2ND FLOOR
City : NEW YORK
State : NY
Zip : 10011-6701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 225 BROADHOLLOW RD STE 402
Second Line :
City : MELVILLE
State : NY
Zip : 11747-4899
Country : US
Telephone Number : 631-385-7780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2010
Last Update Date : 08/28/2019

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