Provider Demographics
NPI:1619059367
Name:WARREN, STACEY G (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:G
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:BUCKINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18912-0215
Mailing Address - Country:US
Mailing Address - Phone:215-750-5525
Mailing Address - Fax:215-750-5538
Practice Address - Street 1:670 WOODBOURNE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-5525
Practice Address - Fax:215-750-5538
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015003103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000582000OtherINDEPENDENCE BLUE CROSS A
2323243000OtherPERSONAL CHOICE
2626143OtherAETNA
2000582000OtherINDEPENDENCE BLUE CROSS A
P38741Medicare UPIN