Provider Demographics
NPI:1053838763
Name:WARREN, RICHARD TRACY II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TRACY
Last Name:WARREN
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5022 VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7850
Mailing Address - Country:US
Mailing Address - Phone:561-602-4554
Mailing Address - Fax:
Practice Address - Street 1:3469 W BOYNTON BEACH BLVD STE 2
Practice Address - Street 2:PMB 1056
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4639
Practice Address - Country:US
Practice Address - Phone:561-299-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW138681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical