Provider Demographics
NPI:1538816467
Name:PAYNE, LAVINA MARIE (MSED)
Entity type:Individual
Prefix:
First Name:LAVINA
Middle Name:MARIE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4840
Mailing Address - Country:US
Mailing Address - Phone:724-953-6792
Mailing Address - Fax:
Practice Address - Street 1:607 WEAVER ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4840
Practice Address - Country:US
Practice Address - Phone:724-953-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst