Provider Demographics
NPI:1689819930
Name:WARREN, MYCHELLE N (EDS)
Entity Type:Individual
Prefix:MS
First Name:MYCHELLE
Middle Name:N
Last Name:WARREN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BRANCH BROOK DR APT D
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3627
Mailing Address - Country:US
Mailing Address - Phone:848-565-6411
Mailing Address - Fax:
Practice Address - Street 1:304 BRANCH BROOK DR APT D
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3627
Practice Address - Country:US
Practice Address - Phone:848-565-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health