Provider Demographics
NPI:1821120361
Name:BERTNER, WARREN LEONARD (MED)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:LEONARD
Last Name:BERTNER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5969 E BROAD ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1546
Mailing Address - Country:US
Mailing Address - Phone:614-759-9595
Mailing Address - Fax:614-759-9596
Practice Address - Street 1:5969 E BROAD ST
Practice Address - Street 2:SUITE 304
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1546
Practice Address - Country:US
Practice Address - Phone:614-759-9595
Practice Address - Fax:614-759-9596
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical