Provider Demographics
NPI:1306928692
Name:PAYNE, SYDELL K (LCSW)
Entity type:Individual
Prefix:
First Name:SYDELL
Middle Name:K
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1627
Mailing Address - Country:US
Mailing Address - Phone:412-441-9786
Mailing Address - Fax:412-363-2375
Practice Address - Street 1:5150 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1627
Practice Address - Country:US
Practice Address - Phone:412-441-9786
Practice Address - Fax:412-363-2375
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125186104100000X
PACW0161121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker