Provider Demographics
NPI:1225355456
Name:WARREN-FARICY, LAUREN HALF (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:HALF
Last Name:WARREN-FARICY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:HALF
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 IRVING AVE STE 1249
Mailing Address - Street 2:INSTITUTE FOR HUMAN PERFORMANCE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1718
Mailing Address - Country:US
Mailing Address - Phone:315-464-2320
Mailing Address - Fax:
Practice Address - Street 1:505 IRVING AVE STE 1249
Practice Address - Street 2:INSTITUTE FOR HUMAN PERFORMANCE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1718
Practice Address - Country:US
Practice Address - Phone:315-464-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102893103G00000X
NY020269103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist