Provider Demographics
NPI:1063984474
Name:JAVED-PAYNE, MARIYA (LICSW, LADC)
Entity type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:JAVED-PAYNE
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W 84TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1367
Mailing Address - Country:US
Mailing Address - Phone:763-232-4694
Mailing Address - Fax:
Practice Address - Street 1:9300 HENNEPIN TOWN RD STE 110
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-3072
Practice Address - Country:US
Practice Address - Phone:763-232-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YA0400X
MN227731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)