Provider Demographics
NPI:1124242367
Name:WARNER, MICHAEL J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:WARNER
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:PO BOX 110520
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32911-0520
Mailing Address - Country:US
Mailing Address - Phone:561-347-1939
Mailing Address - Fax:561-347-2399
Practice Address - Street 1:505 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4921
Practice Address - Country:US
Practice Address - Phone:561-347-1939
Practice Address - Fax:561-347-2399
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003679103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
75846Medicare UPIN