Provider Demographics
NPI:1508166570
Name:WARNKE, MARTINA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:
Last Name:WARNKE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 45TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2308
Mailing Address - Country:US
Mailing Address - Phone:503-325-9710
Mailing Address - Fax:
Practice Address - Street 1:1 12TH ST STE 4
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4146
Practice Address - Country:US
Practice Address - Phone:503-470-9572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional