Provider Demographics
NPI:1952061798
Name:WARMUS, JOHN T (CT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:WARMUS
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3028
Mailing Address - Country:US
Mailing Address - Phone:330-644-4095
Mailing Address - Fax:330-645-2031
Practice Address - Street 1:3445 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY TWP
Practice Address - State:OH
Practice Address - Zip Code:44319-3028
Practice Address - Country:US
Practice Address - Phone:330-644-4095
Practice Address - Fax:330-645-2031
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC2103155-TRNE101Y00000X
OHC.2204190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0478152Medicaid