Provider Demographics
NPI:1962642389
Name:WARNER, KELLY FAYE (MSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:FAYE
Last Name:WARNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:FAYE
Other - Last Name:HUTCHINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 FORD PL # 4B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:131-387-4916
Mailing Address - Fax:
Practice Address - Street 1:23200 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-4551
Practice Address - Country:US
Practice Address - Phone:586-759-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010864811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical