Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 018865 | NY |
Y | 103T00000X | Psychologist | 018865 | NY |
N | 103G00000X | Clinical Psychologist | 018865 | NY |
N | 103TC0700X | Clinical Psychologist | 018865 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 018865 | NY |
NPI | 1114324407 |
---|---|
Provider Name | Caroline Pierpont Payne |
First Address | Troy, NY 12180 |
Second Address | Canandaigua, NY 12180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2014 |
Last Update Date | 02/12/2014 |