Provider Demographics
NPI:1902618994
Name:PAYNE, ANDREA (MSW, PLMHP, PCMSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MSW, PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 WATERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-4832
Mailing Address - Country:US
Mailing Address - Phone:724-709-1391
Mailing Address - Fax:
Practice Address - Street 1:6720 S 178TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3055
Practice Address - Country:US
Practice Address - Phone:402-302-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE81631041C0700X
NE14291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical