Provider Demographics
NPI:1518992007
Name:WARANCH, ELLEN LEA (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:LEA
Last Name:WARANCH
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:WARANCH
Other - Last Name:ASHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:5000 CORPORATE WOODS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4429
Mailing Address - Country:US
Mailing Address - Phone:757-459-4640
Mailing Address - Fax:757-459-4643
Practice Address - Street 1:5000 CORPORATE WOODS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4429
Practice Address - Country:US
Practice Address - Phone:757-459-4640
Practice Address - Fax:757-459-4643
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040023061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8909148Medicaid
VA058166OtherBLUE CROSS
VA800000907Medicare ID - Type Unspecified
VA058166OtherBLUE CROSS