Provider Demographics
NPI:1356481519
Name:WARREN, CHARLES SETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SETH
Last Name:WARREN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:SETH
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:120 HEMLOCK TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1208
Mailing Address - Country:US
Mailing Address - Phone:973-378-3774
Mailing Address - Fax:
Practice Address - Street 1:720 BLOOMFIELD ST APT 1
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5044
Practice Address - Country:US
Practice Address - Phone:201-798-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100264600103TC0700X
NY012663-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJWA042115Medicare ID - Type Unspecified
NJ156090Medicare UPIN