Provider Demographics
NPI:1316412257
Name:WARREN, SUSAN L (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:WARREN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4214
Mailing Address - Country:US
Mailing Address - Phone:501-982-5402
Mailing Address - Fax:501-982-1781
Practice Address - Street 1:2520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4214
Practice Address - Country:US
Practice Address - Phone:501-982-5402
Practice Address - Fax:501-982-1781
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8931-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker