Provider Demographics
NPI:1407897416
Name:WARREN, NANCY GROVEENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:GROVEENE
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:GROVEENE
Other - Last Name:SHOECRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6161 9TH ST N #201
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703
Mailing Address - Country:US
Mailing Address - Phone:727-244-7431
Mailing Address - Fax:727-498-8605
Practice Address - Street 1:6161 9TH ST N #201
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703
Practice Address - Country:US
Practice Address - Phone:727-244-9431
Practice Address - Fax:727-498-8605
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW4966104100000X
FLFLSW49661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768624200Medicaid
FLZ0618Medicare PIN