Provider Demographics
NPI:1053467522
Name:JUDITH L. WARREN, PH.D., P.S.
Entity Type:Organization
Organization Name:JUDITH L. WARREN, PH.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-443-0900
Mailing Address - Street 1:2001 WESTERN AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2163
Mailing Address - Country:US
Mailing Address - Phone:206-443-0900
Mailing Address - Fax:206-728-1180
Practice Address - Street 1:2001 WESTERN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2163
Practice Address - Country:US
Practice Address - Phone:206-443-0900
Practice Address - Fax:206-728-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty