Provider Demographics
NPI:1669522629
Name:WARNELL, KATHY J (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:J
Last Name:WARNELL
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:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0781
Mailing Address - Country:US
Mailing Address - Phone:909-335-0157
Mailing Address - Fax:909-335-0157
Practice Address - Street 1:411 W STATE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4663
Practice Address - Country:US
Practice Address - Phone:909-335-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0637733Medicaid
CA0637733Medicaid