Provider Demographics
NPI:1104856962
Name:WARREN, BARBARA M (LCSW, LMFT)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:M
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 CAMP BOWIE BOULEVARD
Mailing Address - Street 2:#43
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5601
Mailing Address - Country:US
Mailing Address - Phone:817-926-4462
Mailing Address - Fax:817-246-4177
Practice Address - Street 1:6040 CAMP BOWIE BOULEVARD
Practice Address - Street 2:#43
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5601
Practice Address - Country:US
Practice Address - Phone:817-926-4462
Practice Address - Fax:817-246-4177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163191041C0700X
TXS16319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S04ROtherBLUE CROSS & BLUE SHIELD
TX345717000OtherMAGELLAN
TX10812275-02Medicaid
TX1081275-02Medicaid
TX00S04RMedicare UPIN