Provider Demographics
NPI:1972274892
Name:WARWICK, KEITH E
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:E
Last Name:WARWICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9688
Mailing Address - Country:US
Mailing Address - Phone:209-629-1883
Mailing Address - Fax:
Practice Address - Street 1:1390 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9688
Practice Address - Country:US
Practice Address - Phone:209-629-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor