Provider Demographics
NPI:1316145527
Name:PAYNE, JENNIFER SHEPARD (LCSW)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SHEPARD
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 1:7820 PARAGON CIR APT 105
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6547
Mailing Address - Country:US
Mailing Address - Phone:323-488-2040
Mailing Address - Fax:
Practice Address - Street 1:7820 PARAGON CIR APT 105
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6547
Practice Address - Country:US
Practice Address - Phone:323-488-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28510104100000X
CALCS 190531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker