Provider Demographics
NPI:1063502060
Name:WARREN, LUCIANNE W (LCSW)
Entity Type:Individual
Prefix:
First Name:LUCIANNE
Middle Name:W
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5268 GODWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8135
Mailing Address - Country:US
Mailing Address - Phone:757-255-7117
Mailing Address - Fax:757-255-7139
Practice Address - Street 1:5268 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8135
Practice Address - Country:US
Practice Address - Phone:757-255-7117
Practice Address - Fax:757-255-7139
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA082-03-002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8904961Medicaid
VA8904987Medicaid
VA8905061Medicaid
VA320785OtherBC/BS
VA8904995Medicaid
VA270368OtherBC/BS
VA800000852Medicare ID - Type Unspecified
VA8904995Medicaid