Provider Demographics
NPI:1023081106
Name:WARNER, MARY LADD (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LADD
Last Name:WARNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 1/2 N CASCADE AVE
Mailing Address - Street 2:APARTMENT #6
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2362
Mailing Address - Country:US
Mailing Address - Phone:719-328-9301
Mailing Address - Fax:719-328-9301
Practice Address - Street 1:1206 1/2 N CASCADE AVE
Practice Address - Street 2:APARTMENT #6
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2362
Practice Address - Country:US
Practice Address - Phone:719-328-9301
Practice Address - Fax:719-328-9301
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1182101Y00000X, 1041C0700X
CO#1182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ050SZMedicare ID - Type Unspecified