Provider Demographics
NPI:1205224953
Name:WARNKE, JULIETTE YVONNE
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:YVONNE
Last Name:WARNKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIETTE
Other - Middle Name:BARTLEY
Other - Last Name:WARNKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CAP
Mailing Address - Street 1:2864 64TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5555
Mailing Address - Country:US
Mailing Address - Phone:727-643-2585
Mailing Address - Fax:
Practice Address - Street 1:4024 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1239
Practice Address - Country:US
Practice Address - Phone:727-327-7656
Practice Address - Fax:727-896-1426
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health