Provider Demographics
NPI:1962736173
Name:PAYNE, JUDE CHRISTINE (MSW)
Entity type:Individual
Prefix:MS
First Name:JUDE
Middle Name:CHRISTINE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JUDE
Other - Middle Name:CHRISTINE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3405 PAN AMERICAN FWY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4786
Mailing Address - Country:US
Mailing Address - Phone:505-222-0332
Mailing Address - Fax:505-222-0301
Practice Address - Street 1:3405 PAN AMERICAN FWY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4786
Practice Address - Country:US
Practice Address - Phone:505-222-0332
Practice Address - Fax:505-222-0301
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-058921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1041CO700XMedicaid