Provider Demographics
NPI:1790866929
Name:WARREN, SHARON R (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:R
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:
Other - Last Name:STEMBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, HSPP
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:IN
Mailing Address - Zip Code:47944-0307
Mailing Address - Country:US
Mailing Address - Phone:765-884-1506
Mailing Address - Fax:765-884-1507
Practice Address - Street 1:303 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:IN
Practice Address - Zip Code:47944
Practice Address - Country:US
Practice Address - Phone:765-884-1506
Practice Address - Fax:765-884-1507
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041072A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35-2147312Medicaid
IN35-2147312Medicaid