Provider Demographics
NPI:1265100382
Name:WARSHAWER, COLLEEN KERRY (EDS)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:KERRY
Last Name:WARSHAWER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:KERRY
Other - Last Name:AGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-0368
Mailing Address - Country:US
Mailing Address - Phone:505-657-1633
Mailing Address - Fax:
Practice Address - Street 1:61 DEL SOL TRAIL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508
Practice Address - Country:US
Practice Address - Phone:505-470-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM356319103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty