Active NPI
Michelle Payton
- Clinical Social Worker
- Fairfield, CA
National Provider Identifier
1619495694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 114078
- Practice address
- 2188 Monterey Dr
Fairfield, CA 94534 - Phone
- (510) 388-0382
- NPI assigned
- Aug 30, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 90549 | ||
| Clinical Social Worker | 1041C0700X | 114078 | CA | Primary |
Addresses
Primary practice location
2188 Monterey Dr
Fairfield, CA 94534
Mailing address
4470 W Sunset Blvd Ste 107
Los Angeles, CA 90027-6309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 19, 2023 through Dec 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114078 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1619495694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4470 W SUNSET BLVD STE 107",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900276309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2188 MONTEREY DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "94534",
"telephone_number": "510-388-0382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYTON",
"first_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-30",
"last_updated": "2023-08-15",
"certification_date": "2023-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": "90549",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "114078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.