Provider Demographics
NPI:1205872892
Name:WARREN, MARY HEARN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HEARN
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:HEARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3349 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33024-9000
Mailing Address - Country:US
Mailing Address - Phone:954-885-9500
Mailing Address - Fax:
Practice Address - Street 1:3349 N UNIVERSITY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33024-9000
Practice Address - Country:US
Practice Address - Phone:954-885-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 55681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0134Medicare ID - Type Unspecified