Provider Demographics
NPI:1982252672
Name:WARNER, TIA ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:ROSE
Last Name:WARNER
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 1:24 ALLIED WAY
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ME
Mailing Address - Zip Code:04040-4042
Mailing Address - Country:US
Mailing Address - Phone:207-450-5773
Mailing Address - Fax:
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5643
Practice Address - Country:US
Practice Address - Phone:207-739-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC181671041C0700X
MELC215261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical