Provider Demographics
NPI:1083796536
Name:WARNER, MARY H (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:WARNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:H
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:B5552
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-4395
Mailing Address - Fax:206-987-2649
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-4395
Practice Address - Fax:206-987-2649
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000974103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS242WAMedicaid
WA8372591Medicaid