Provider Demographics
NPI:1316264104
Name:PAYNE, ERYN MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:ERYN
Middle Name:MARY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ERYN
Other - Middle Name:MARY
Other - Last Name:SHUMWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 SOUTH BROADWAY
Mailing Address - Street 2:UNIT R6
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591
Mailing Address - Country:US
Mailing Address - Phone:914-949-7699
Mailing Address - Fax:914-949-3224
Practice Address - Street 1:141 NO. CENTRAL AVENUE
Practice Address - Street 2:C/O WJCS
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-949-7699
Practice Address - Fax:914-949-3224
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081171104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400095945Medicare PIN