Provider Demographics
NPI:1659416840
Name:MERRILL WARNER, VERONIQUE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VERONIQUE
Middle Name:
Last Name:MERRILL WARNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 S RANDOLPH AVE
Mailing Address - Street 2:SUITE #165
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5754
Mailing Address - Country:US
Mailing Address - Phone:714-582-2149
Mailing Address - Fax:714-544-1473
Practice Address - Street 1:265 S RANDOLPH AVE
Practice Address - Street 2:SUITE #165
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5754
Practice Address - Country:US
Practice Address - Phone:714-582-2149
Practice Address - Fax:714-544-1473
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17353103T00000X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent