Provider Demographics
NPI:1336701614
Name:WARREN, RAMSEY LEIGH
Entity Type:Individual
Prefix:
First Name:RAMSEY
Middle Name:LEIGH
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S LAKE DESTINY RD STE 350
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7222
Mailing Address - Country:US
Mailing Address - Phone:407-618-0493
Mailing Address - Fax:
Practice Address - Street 1:601 S LAKE DESTINY RD STE 350
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7222
Practice Address - Country:US
Practice Address - Phone:407-618-0493
Practice Address - Fax:855-864-1499
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-23-65316103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician