Provider Demographics
NPI:1649357906
Name:WARREN, KEVIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:WARREN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KALISA WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3508
Mailing Address - Country:US
Mailing Address - Phone:888-948-6789
Mailing Address - Fax:877-345-3501
Practice Address - Street 1:8911 E ORME ST
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2423
Practice Address - Country:US
Practice Address - Phone:316-686-7884
Practice Address - Fax:316-686-0036
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100355960BMedicaid
KS100355960BMedicaid