Provider Demographics
NPI:1073352415
Name:WARREN, STEPHANIE BEATRICE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BEATRICE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 KRAUSE RD UNIT 624
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-1225
Mailing Address - Country:US
Mailing Address - Phone:804-504-1388
Mailing Address - Fax:
Practice Address - Street 1:10221 KRAUSE RD UNIT 624
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-1225
Practice Address - Country:US
Practice Address - Phone:804-504-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker