Provider Demographics
NPI:1083784318
Name:WARREN PSYCHIATRIC SERVICES PA
Entity Type:Organization
Organization Name:WARREN PSYCHIATRIC SERVICES PA
Other - Org Name:GEORGE L WARREN MD CAROL K MILLER LCSW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY FOR PA
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-298-8338
Mailing Address - Street 1:516 LAKEVIEW ROAD
Mailing Address - Street 2:VILLA 9
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3302
Mailing Address - Country:US
Mailing Address - Phone:727-298-8338
Mailing Address - Fax:727-298-0381
Practice Address - Street 1:516 LAKEVIEW ROAD
Practice Address - Street 2:VILLA 9
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3302
Practice Address - Country:US
Practice Address - Phone:727-298-8338
Practice Address - Fax:727-298-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
52778ZOtherBC/BS
Z5740ZOtherBLUE CROSS/BLUE SHIELD
FLK4416Medicare ID - Type Unspecified
52778ZOtherBC/BS