Provider Demographics
NPI:1205419454
Name:WARNER, MARIA NICOLE (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:NICOLE
Last Name:WARNER
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 GLEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3032
Mailing Address - Country:US
Mailing Address - Phone:813-528-5024
Mailing Address - Fax:
Practice Address - Street 1:614 GLEN WAY NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3032
Practice Address - Country:US
Practice Address - Phone:813-528-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLSW199151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker