Provider Demographics
NPI:1225540859
Name:WARNER, CAROLYN R (CBT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:WARNER
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3709
Mailing Address - Country:US
Mailing Address - Phone:206-941-4309
Mailing Address - Fax:
Practice Address - Street 1:9714 3RD AVE NE STE 206
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2046
Practice Address - Country:US
Practice Address - Phone:206-397-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-17-42735106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician