Provider Demographics
NPI:1093522302
Name:PAYNE, KIRSTEEN ANN (ASW)
Entity type:Individual
Prefix:
First Name:KIRSTEEN
Middle Name:ANN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 KEARNY MESA RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3771
Mailing Address - Country:US
Mailing Address - Phone:858-377-6941
Mailing Address - Fax:
Practice Address - Street 1:4240 KEARNY MESA RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3771
Practice Address - Country:US
Practice Address - Phone:858-377-6941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1262101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical