Provider Demographics
NPI:1205685872
Name:SENIOR, WARREN RAYMOND JR
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:RAYMOND
Last Name:SENIOR
Suffix:JR
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 1:4380 BRONX BLVD # 70
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1318
Mailing Address - Country:US
Mailing Address - Phone:917-749-6158
Mailing Address - Fax:
Practice Address - Street 1:4380 BRONX BLVD # 70
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1318
Practice Address - Country:US
Practice Address - Phone:917-749-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst