Provider Demographics
NPI:1093204117
Name:WARREN, JARED LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:LEE
Last Name:WARREN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 27TH ST W STE 125
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1759
Mailing Address - Country:US
Mailing Address - Phone:941-753-0064
Mailing Address - Fax:
Practice Address - Street 1:4835 27TH ST W STE 125
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1759
Practice Address - Country:US
Practice Address - Phone:941-753-0064
Practice Address - Fax:866-636-1355
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical